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A� or CERTIFICATE OF LIABILITY INSURANCE DA7 (MMd`D 21) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER NAME: PHONE (661)266-9390 A/C. Ne: I6611366-9391 Driscoll S Driscoll Insurance Agency, Inc. EMAIL ADDRESS: Certs@DriscollandDriscoll.com 41235 llth St West, Suite A INSURER $ AFFORDING COVERAGE NAIC # INSURER A: Nautilus Insurance Company Palmdale CA 93551 INSURED INSURERB:American Fire and Casualty Company INSURER C: Insurance Company of the West INSURER D: Chambers Group, Inc INSURER E: 5 Hutton Center Drive, Suite 750 INSURER F: Santa Ana CA 92707 COVERAGES CERTIFICATE NUMBER: CL216316535 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF ADDL SUBR POLICY NUMBER POLICYEFF MMIDDIYYYY POLICYEXP MMIDDIYYYY LIMITS A X COMMERCIAL GEN ERAL LIABILITY CLAIMS MADE � OCCUR EACH OCCURRENCE $ 2,000,000 DAMAGES(E..c RENTED PREMISES ETO ENTEDence $ 100,000 MED EXP(Any one person S 10,000 X Y ECP2026303-13 6/1/2021 6/1/2022 PERSONAL ItADV INJURY $ 1,000,000 GEN%AGGREGATE LIMITAPPLIES PER: X POLICY ❑ JEGOT LOG GENERALAGGREGATE $ 2,000,000 PRODUCTS-COMP/OPAGG $ 2,000,000 $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accitlent $ 1,000,000 X BODILY INJURY (Per person) $ B ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BAA (22) 63 41 76 16 6/1/2021 6/1/2022 BODILY INJURY (Per accident) $ NON-0WNED HIREDAUTOS AUTOS PROPERTY DAMAGE Per accident) $ UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 10 000,000 X AGGREGATE $ 10,000,000 A EXCESSUAB CLAIMS -MADE DED RETENTION $ $ FM026322-13 6/1/2021 6/1/2022 C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIEfORIPARTNERIEXECUTIVE OFFICEWMEMBER EXCLUDED? NIA WV6 5055233 01 5/12/2D21 5/12/2022 X PER OTH- STATUTE ER E.L. EACH ACCIDENT $ 11000,000 E.L. DISEASE - EA EMPLOYEE $ 11000,000 (Mandatory In NH) It yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $ 1,000,000 A Contr Pollution Liability ECP2026303-13 6/1/2021 6/1/2022 Pm Ow)Agg 1 M / 2 M A I Professional Liability ECP2026303-13 6/1/2021 6/1/2022 Claims Mads 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may he attached If mare space Is mquimd) Blanket Waiver applies to the General Liability Policy per form # ECP 1260 01 21. Blanket Primary 6 Non -Contributory wording applies to the General Liability Policy per form # ECP 1246 01 21. Blanket Additional Insured applies to the General Liability Policy per form # ECP 1246 01 21 6 ECP 124B 01 21; in favor of: City of Santa Ana, officers, agents, employees, and volunteers. ID day Notice of Cancellation for Non-payment 6 day for all other. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Santa Ana THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Risk Management Division ACCORDANCE WITH THE POLICY PROVISIONS. 20 Civic Center Plaza AUTHORIZED REPRESENTATIVE Santa Ana, CA 92702 ROSS Driscoll, Sr/DM /JC p70 �ja,y.y. ACORD 25 (2014101) INS025 (201401) ©1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD