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AC(:>)?IY CERTIFICATE OF LIABILITY INSURANCE <br />1111 3/29/2022 <br />DATE(MMIDDIYYYY) <br />4/2/2021 <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 Lockton Companies <br />t 185 Avenue of the Americas, Suite 2010 <br />New York NY 10036 <br />646-572-7300 <br />CONTACT <br />PHONE FA% <br />AIC. No E A/C No: <br />EMAIL <br />ADDRESS: <br />INSURERS AFFORDING COVERAGE <br />NAIC# <br />INSURER A: ACE Property & Casualty Insurance Co <br />20699 <br />INSURED Property Registration Chamions <br />1461671 <br />DBA Prochamps <br />INSURER B : Lloyd <br />--s of London <br />INSURER C : Zurich American Insurance Company <br />16535 <br />2725 Center Place, Ste 102 <br />Melbourne FL 32940 <br />INSURER D <br />INSURER E : <br />INSURER F : <br />COVERAGES CERTIFICATE NUMBER: 16839103 REVISION NUMBER: XXXXXXX <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 />IN <br />TR <br />TYPE OF INSURANCE <br />ADDL <br />INSID <br />SUBR <br />MID <br />POLICY NUMBER <br />POLICY EFF <br />MMIDDIYYYY <br />POLICY EXP <br />MMIDDII'YVY <br />LIMITS <br />A <br />X <br />COMMERCIAL GENERAL LIABILITY <br />CLAIMS -MADE X OCCUR <br />Y <br />N <br />D94762558 <br />3/29/2021 <br />3/29/2022 <br />EACH OCCURRENCE <br />$ 1,000,000 <br />TED <br />PREMISES Ea occurrence) <br />$ 1,000,000 <br />MED EXP (Anyone person) <br />$ 5,000 <br />PERSONAL B ADV INJURY <br />$ 1000000 <br />AGGREGATE LIMIT APPLIES PER: <br />POLICY [::] PE' 11 LOC <br />GENERAL AGGREGATE <br />$ 2000000 <br />GEN'L <br />X <br />PRODUCTS - COMP/OP AGO <br />1 2,000,000 <br />$ <br />OTHER: <br />A <br />AUTOMOBILE <br />LIABILITY <br />Y <br />NT <br />D94762558 <br />3/29/2021 <br />3/29/2022 <br />COMBINED <br />MBI deDISINGLE LIMIT <br />$ 1 000 000 <br />Ix <br />ANY AUTO <br />OWNED SCHEDULED <br />AUTOS ONLY AUTOS <br />BODI LV INJURY (Par person) <br />$ XXXXXXX <br />BODILY INJURY (Per accitlent) <br />_ <br />—PROPERTY <br />$ XXXXXXX <br />HIRED <br />AUTOS ONLY X AUTOS ONLY <br />acciden DAMAGE <br />$ XXXXXXX <br />$XXXXXXX <br />A <br />LIAB <br />OCCUR <br />N <br />N <br />D9476256A <br />3/29/2021 <br />3/29/2022 <br />EACH OCCURRENCE <br />$ 5,000,000 <br />IUMBRELLA <br />EXCESS LIAB <br />CLAIMS -MADE <br />AGGREGATE <br />$ 5 000 000 <br />DIED RETENTION$ <br />$ XXXXXXX <br />WORKERS COMPENSATION <br />ANDEMPLOVERS'LIABILITY YIN <br />ANY PROPRIETORIPARTNEWEXECUTIVE <br />OFFICEPoMEMBER EXCLUDED? <br />(Mandatory In NH) <br />If Yes, describe under <br />NIA <br />NOT APPLICABLE <br />PER OTH- <br />STATUTE ER <br />E.L. EACH ACCIDENT <br />$ XXXXXXX <br />E.L. DISEASE - EA EMPLOYEE <br />$ XXXXXXX <br />E.L. DISEASE- POLICY LIMIT <br />$ XXXXXXX <br />DESCRIPTION OF OPERATIONS below <br />B <br />Professional <br />Liabitlty/Cyber <br />Crime <br />N <br />N <br />CT1137121 <br />4/1/2021 <br />4/1/2022 <br />Limit:. 000,000 <br />Retention: $25,000 <br />Limit: $1,000,000 <br />C I <br />I <br />I <br />I <br />MPL 6359954-01 <br />4/1/2021 <br />4/l/2022 <br />Retention: $50,000 <br />DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required) <br />City of Santa Ana are included as additional insured on a primary and non-contributory basis as required by written contract. Thirty (30) Day Notice of <br />Cancellation, except Ten (10) Day Notice of Cancellation for Non -Payment of Premium, applies. <br />16839103 <br />City of Santa Ana <br />Risk Management Divison <br />20 Civic Center Plaza, 4th Floor <br />Santa Ana CA 92701 <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />AUTHORIZED <br />©1988.2016 ACORD <br />reserved. <br />ACORD 25 (2016103) <br />The ACORD name and logo are registered marks of ACORD <br />