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." CCW?& DATE (MMIDDrYYYY) CERTIFICATE OF LIABILITY INSURANCE 09)2=021 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 INSURERS), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or 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 S$aItEFFa!'fn TELL BOWERSOX 24681 LA PLAZA, STE 360 ® CONTACT NAME:TED BOWERSOX NAME: PHONE o 94Ertl:9-661-3200 FA�X No : 949-661-4119 WC E-MAIL IESS: — DANA POINT, CA 92629 lNSURER(S) AFFORDING COVERAGE _ iVAIC q INSURER A: State Farm Fire and Casualty Company 25143 _ INSURED INSURERS: INSURER C : JAMES GARTNER & ASSOCIATES INC, WSURERO: 2036 N BROADWAY _ INSURER E : SANTA ANA, CA 92706 INSURER F ' COVERAGES CERTIFICATE NUMBER: 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 CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE 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 ADDL..SUBR POLICY EFF POLICY EXP - LTR TYPE OF INSURANCE POLICY NUMBER MMIDD1YYYY MMIDD LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS -MADE OCCUR TE PREMISES a occurrence $ MED EXP (Any one person) $ PERSONAL &ADV INJURY S AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ GEN'L POLICY [] JEd [] LOC PRODUCTS-COMPfOPAGG - $ _ $ OTHER: 1 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea ao¢idenD $ 90OtLY VNJURY (Per person) $ ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ $ _ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE (Per accidents $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED RETENTION $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNERIEXECUTIVE YIN OPFICERIMEMDER EXCLUDED? 0 (Mandatory In NH) NIA Y 92-GQ-D892-8F 01/22/2021 01122/2022 STATUTE ERH E.L. EACH ACCIDENT S 1 �� E.L. DISEASE - EA EMPLOYE $ 1,000,000 E.L. DISEASE - POLICY LIMIT 1,000,000 iryes, describe under DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Addltional Remarks Schedule, may be attached if more space Is required) CITY OF SANTA ANA, ITS OFFICERS, EMPLOYEES, AGENTS AND REPRESENTATIVES ARE ADDITIONAL INSUREDS WITH RESPECT TO GENERAL AND AUTO LIABILITY, INSURANCE IS PRIMARY AND NONCONTRIBUTORY. WAIVER OF SUBROGATION APPLIES TO WORKERS COMPENSiGN. 30 DAY NOTICE OF CANCELLATION110 DAY ON-PAYMEN OF PREMIUM CERTIFICATE HOLDER CANCELLATION CITY OF SANTA ANA RISK MANAGEMENT DIVISION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE 20 CIVIC CENTER PLAZA SANTA ANA, CA 92702 dt Risk Managl'merd'DiAsian / � ortaN�F z REVIEWED & APPROVED BY: Oa 1988-2015 ACORD �a ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD _W Risk Management Analyst