SEASIDE ICE, LLC DBA ICE-AMERICA

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Samantha M. Digitally signed by Samantha M. I 1, + Lambert V ACOR�� CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 1 10/26/2021 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 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 Gaspar Insurance Services, Inc. 23161 Ventura Blvd, Suite 100 Woodland Hills CA 91364 CONTACT NAME: CSERVICE PHONE 8183023060 a/c No: A/c No Ext: ADODRESS: cservice@gasparinsurance.com INSURER(S) AFFORDING COVERAGE NAIC # INSURERA: New York Marine And General In 16608 License#: OG66626 INSURED SEASICE-01 Seaside Ice, LLC DBA Ice -America 807 Sprucelake Drive INSURER B : INSURERC: INSURER D 7 Harbor City CA 90710 INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER:361409294 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 LTR TYPE OF INSURANCE ADDL INSD SUBR WVD POLICYNUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY Y Y PK202000012079 10/26/2021 10/26/2022 EACH OCCURRENCE $1,000,000 CLAIMS -MADE OCCUR PREM SES Ea occurrence) $ 100,000 MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 PRO- POLICY ❑ LOC JECT X PRODUCTS - COMP/OP AGG $ 2,000,000 $ OTHER: A AUTOMOBILE LIABILITY Y Y AU202000014259 10/26/2021 10/26/2022 COEaMB cciINED dentdentS NGLE LIMIT a $1,000,000 BODILY INJURY (Per person) $ ANY AUTO OWNED X SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ X PROPERTY DAMAGE Per accident $ HIRED X NON -OWNED AUTOS ONLY AUTOS ONLY A UMBRELLA LAB X OCCUR Y Y UM20200006174 10/26/2021 10/26/2022 EACH OCCURRENCE $ 5,000,000 X AGGREGATE $5,000,000 EXCESS LAB CLAIMS -MADE DED X RETENTION $ in nnn $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANYPROPRIETOR/PARTNER/EXECUTIVE WC202000015566 10/26/2021 10/26/2022 X PER OTH- STATUTE ER E.L. EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? NIA E.L. DISEASE- EA EMPLOYEE $ 1,000,000 (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE- POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS/ LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) This policy includes a Blanket Additional Insured Endorsement — the certificate holder is an additional insured if required by written contract. Please refer to the attached endorsement. The City of Santa Ana, its officers, officials, employees, and volunteers are additional insured if required by written contract. Please refer to the attached endorsement. RE: 2021 Santa Ana Winter Village CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Santa Ana ACCORDANCE WITH THE POLICY PROVISIONS. Risk Management Division 20 Civic Center Plaza AUTHORIZED REPRESENTATIVE Santa Ana CA 92702 --� �„ oR,N� RirohMr:ta�etna�lDiviaian REVIEWED&APPROVED BY. ©1988-2015 ACORD CO ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD ` Risk Management Supervisor