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Dig{affy signed by Francine R. <br />Francine R. <br />�,Iareal <br />Villareal Date: 2022.01.1011.33.33 <br />ACCORD® CERTIFICATE OF LIABILITY INSURANCE <br />DATE(MM/DD/YYYY) <br />12/30/2021 <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 or 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 endorsement(s). <br />PRODUCER <br />Bowermaster & Associates <br />P.O. Box 6026 <br />Holder St Suite 350 <br />CONTACT <br />Melissa Altergott <br />PHONE FAX <br />A/C No Ext : 714-733-6200 A/C, No): <br />E-M10805 <br />ADDRESS: maltergott@bowermaster.com <br />INSURER(S) AFFORDING COVERAGE <br />NAIC# <br />Cypress CA 90630 <br />INSURERA: Valley Forge Insurance Company <br />20508 <br />INSURED FMTHOMA-01 <br />FM Thomas Air Conditioning, Inc. <br />231 Gemini Ave. <br />INSURERB: Continental Casualty Co. <br />20443 <br />INSURERC: Continental Insurance Company <br />35289 <br />INSURERD: Insurance Company of the West <br />27847 <br />Brea CA 92821 <br />INSURER E : <br />INSURER F : <br />COVERAGES CERTIFICATE NUMBER: 1643747848 REVISION NUMBER: <br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN 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 BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />INSR <br />LTR <br />TYPE OF INSURANCE <br />ADDL <br />INSD <br />SUBR <br />WVD <br />POLICYNUMBER <br />POLICY EFF <br />MM/DD <br />POLICY EXP <br />MM/DD <br />LIMITS <br />A <br />X <br />COMMERCIAL GENERAL LIABILITY <br />Y <br />6057223216 <br />4/1/2021 <br />4/1/2022 <br />EACH OCCURRENCE <br />$1,000,000 <br />CLAIMS -MADE OCCUR <br />DAMAGE TO RENTED <br />PREMISES Ea occurrence <br />$ 100,000 <br />MED EXP (Any one person) <br />$ 15,000 <br />PERSONAL &ADV INJURY <br />$ 1,000,000 <br />GEN'L <br />AGGREGATE LIMIT APPLIES PER: <br />GENERAL AGGREGATE <br />$ 2,000,000 <br />POLICY ❑PRO ❑ <br />JECT LOC <br />X <br />PRODUCTS - COMP/OP AGG <br />$ 2,000,000 <br />$ <br />OTHER: <br />B <br />AUTOMOBILE <br />LIABILITY <br />6057258063 <br />4/1/2021 <br />4/1/2022 <br />COMBINED SINGLE LIMIT <br />Ea accident <br />$1,000,000 <br />X <br />BODILY INJURY (Per person) <br />$ <br />ANY AUTO <br />OWNED SCHEDULED <br />AUTOS ONLY AUTOS <br />BODILY INJURY (Per accident) <br />$ <br />X <br />PROPERTY DAMAGE <br />Per accident <br />$ <br />HIRED X NON -OWNED <br />AUTOS ONLY AUTOS ONLY <br />C <br />X <br />UMBRELLALIAB <br />X <br />OCCUR <br />6057258077 <br />4/1/2021 <br />4/1/2022 <br />EACH OCCURRENCE <br />$4,000,000 <br />AGGREGATE <br />$ 4,000,000 <br />EXCESS LAB <br />CLAIMS -MADE <br />DED X RETENTION $ 1 n nnn <br />$ <br />D <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY Y / N <br />WSD505258302 <br />1/1/2022 <br />1/1/2023 <br />X PER OTH- <br />STATUTE ER <br />ANYPROPRIETOR/PARTNER/EXECUTIVE <br />E.L. EACH ACCIDENT <br />$ 1,000,000 <br />OFFICER/MEMBER EXCLUDED? ❑ <br />N/A <br />E.L. DISEASE - EA EMPLOYEE <br />$ 1,000,000 <br />(Mandatory in NH) <br />If yes, describe under <br />DESCRIPTION OF OPERATIONS below <br />E.L. DISEASE - POLICY LIMIT <br />$ 1,000,000 <br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) <br />City of Santa Ana, its officers, agents, employees, and representatives are Additional Insured as respects General Liability per attached policy endorsement <br />form; Primary and Non -Contributory wording applies. 30-day notice of cancellation is provided per policy provisions; 10-day notice of cancellation for <br />non-payment. <br />CERTIFICATE HOLDER CANCELLATION <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, <br />NOTICE WILL <br />BE DELIVERED IN <br />City of Santa Ana <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />Risk Management Division <br />Civic Center <br />20 Santa Ana ter Plaza, floor <br />92701 <br />EDREPRESENTATIVE <br />�w cF <br />19 <br />Risk Mwag mentDMsian <br />REVIEWED & APPROVED BY.- <br />@ 1988-2015 ACORD C <br />ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD <br />_ _— <br />Wsk Management Analyst <br />