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AC"RDr CERTIFICATE OF LIABILITY INSURANCE <br />F DATE(MMIDDIYYYY) <br />lh.� <br />1 0811712021 <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER, THIS <br />CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES <br />BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED <br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. <br />IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions of be endorsed. <br />If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on <br />this certificate does not confer rights to the certificate holder in lieu Of such endorsomont(s). <br />PRODUCER <br />CSIS Insurance Services <br />coNTAcr - C519 Insurance Serving <br />NAME: <br />?h ONE Em,($$$} 561-2747 Nd (805)446-4881 <br />ADDRESS: CertfiFCates@csisOnllne. oorn <br />3315 Old ConejO Road <br />Thousand Oaks CA 91320 <br />INSURERISI AFFORDING COVERAGE <br />NAIC <br />INSURER A Benchmark Insurance Company <br />41394 <br />INSURED <br />ER B <br />SLS Property Solutions Inc <br />ER C <br />1776 Park Ave. <br />R O <br />LINSURER <br />Suite 4-Z71 <br />R E: <br />Park City UT 84060 <br />F <br />GQVERAGES CERTIFICATE NUMBER: Maste as of 7/1S2021 QFVLcInNI M11NaRFa! <br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE SEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD <br />INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br />CERTIFICATE MAY HE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TOALL THE TERMS, <br />EXCLUSIONSAND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED 8Y PAID CLAIMS. <br />INSR <br />LTR <br />TYPE OF INSURANCE <br />INSO <br />WVD <br />POLICY NUMBER <br />POLICYEFF <br />MMIDD?YYYY) <br />POLICYEXP <br />(MMJD <br />UMtrS <br />COMMERCIAL GENERAL LIABILITY <br />EACH OCCURRENCE <br />S <br />PREMISES En osaurrenoo <br />_ <br />S <br />CLAIMS -MADE OCCUR <br />MED EXP iAny one parson) <br />S <br />PERSONAL A ADV INJURY <br />S <br />AGGREGATE LIMIT APPLIES PER. <br />GENERALAGGREGATE <br />$ <br />GEN'L <br />❑ Q ❑ <br />POLICY JPE LOC <br />PRODUCTS -COMP14P AGG <br />S <br />$ <br />OTHER <br />AUTOMOBILE <br />LIABILITY <br />COMBINED SINGLE LIMIT <br />i <br />Ea accklsnt <br />ANY AUTO <br />BODILY INJURY (Per parson) <br />$ <br />OWNED SCHEDULED <br />BCD ILYINJURY (Per accaent) <br />$ <br />AUTOS ONLY AUTOS <br />HIRED NON -OWNED <br />PROPERTY DAMAGE <br />$ <br />AUTOS ONLY AUTOS ONLY <br />Par acctide.Id <br />UMBRELLA UAa <br />HCLAIMS-MADE <br />OCCUR <br />EACH OCCURRENCE <br />S <br />EXCESS LIAB <br />ACGREGATE <br />$ <br />DEC) RETENTION S <br />$ <br />WORKERS COMPENSATION <br />PER OTH- <br />AND EMPLOYLKWLIABILITY YIN <br />STATUTE ER <br />EL EACH ACCIDENT <br />$ 1,000,006] <br />A <br />ANY PROPRIETOROPARTNERIEXECUTIVE <br />OFF ICERIMEMSER EXCLUDED? <br />NIA <br />Y <br />CST5021968 <br />07128/2021 <br />07128/2022 <br />E.L. DISEASE - EA EMPLOYEE <br />S 1 •D�,{]7}D <br />(Mandatary In NH) <br />If Yes, dascriha under <br />E.L. DISEASE - POLICY LIMIT <br />S 1.00C,000 <br />DESCRIPTION CF OPERATIONS below <br />DESCRIPTION OF OPERATIONS 1 LOCATIONS) VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more apace is required) <br />City of Sam[a Ana. A Waiver of Subrogation is granted for Workers' Compensation it accordance with the policy's provisions, per attached. <br />re: <br />Agreement# A-20147-219 <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />City of Santa Ana ACCORDANCE WITH THE POLICY PROVISIONS. <br />Risk Management Division <br />AUTHORIZED REPRESENTATIVE <br />20 Civic Center Plaza 4ttn FI <br />Santa Ana CA 92701 <br />CI) 1988-2015ACORD COI <br />ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD Risk ManaginminrtfD^+sio^ <br />RrmE%rrED 6 APPROVED BY.' <br />Risk Managerrcnt Genes) Aide <br />