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AC4C7WL> CERTIFICATE OF LIABILITY INSURANCE <br />DATE (MM/DD/YYYY) <br />07/23/2024 <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 />CONTACT Kasey Litz <br />NAME: <br />Stanton and Associates Inc. <br />PHONE <br />Ext : (805) 413-1498 NC No : (805) 435-3737 <br />ISU Stanton & Associates <br />E-MAIL kasey@isustanton.com <br />ADDRESS: <br />INSURER(S) AFFORDING COVERAGE <br />NAIC # <br />3625 Thousand Oaks Blvd #292 <br />Westlake Village CA 91362 <br />INSURERA: HARTFORD FIRE INSURANCE CO. <br />19682 <br />INSURED <br />INSURER B : Trumbull Ins. Co. <br />27120 <br />Burke, Williams & Sorensen, LLP <br />INSURER C : Hartford Casualty Ins Cc <br />29424 <br />444 S. Flower St., Suite 2400 <br />INSURER D : Sentinel Insurance Company Ltd <br />11000 <br />INSURER E <br />Los Angeles CA 90071 <br />INSURER F <br />COVERAGES CERTIFICATE NUMBER: 24-25 City REVISION NUMBER: <br />THIS IS TO CERTIFYTHAT 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br />CERTIFICATE MAYBE 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 />UBR <br />WVD <br />POLICY NUMBER <br />POLICY EFF <br />MM/DD YYYYMMIDD <br />POLICY EXP <br />Y YY <br />LIMITS <br />X <br />COMMERCIAL GENERAL LIABILITY <br />EACH OCCURRENCE <br />$ 1,000,000 <br />� OCCUR <br />DAMAGE <br />PPENTED <br />REM SESOEa occu".nce <br />$ 300,000 <br />_7CLAIMS-MADE <br />MED EXP (Any one person) <br />$ 10,000 <br />PERSONAL& ADV INJURY <br />$ 1,000,000 <br />A <br />72UUNBD3RBC <br />08/01/2024 <br />08/01/2025 <br />GEN'LAGGREGATE LIMITAPPLIES PER: <br />GENERAL AGGREGATE <br />$ 2,000,000 <br />POLICY ❑ PRO FX LOC <br />JECT <br />PRODUCTS-COMP/OPAGG <br />$ 2,000,000 <br />$ <br />OTHER: <br />AUTOMOBILE <br />LIABILITY <br />COMBINED SINGLE LIMIT <br />Ea accident <br />$ 1,000,000 <br />BODILY INJURY (Per person) <br />$ <br />ANYAUTO <br />B <br />OWNED SCHEDULED <br />AUTOS ONLY AUTOS <br />72UENCG7716 <br />08/01/2024 <br />08/01/2025 <br />BODILY INJURY (Per accident) <br />$ <br />X <br />PROPERTY DAMAGE <br />Per accident <br />$ <br />HIRED �/ NON -OWNED <br />AUTOS ONLY /� AUTOS ONLY <br />X <br />UMBRELLA LIAB <br />X <br />OCCUR <br />EACH OCCURRENCE <br />$ 10,000,000 <br />AGGREGATE <br />$ <br />C <br />EXCESS LIAB <br />CLAIMS -MADE <br />72XHUBF3DCB <br />08/01/2024 <br />08/01/2025 <br />DED I X1 RETENTION $ 10,000 <br />$ <br />D <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY YIN <br />ANY PROPRIETOR/PARTNER/EXECUTIVE <br />OFFICER/MEMBER EXCLUDED? ❑ <br />(Mandatory in NH) <br />NIA <br />72WEAB2915 <br />08/01/2024 <br />08/01/2025 <br />X STATUTE EORH <br />E.L. EACH ACCIDENT <br />1,000,000 <br />$ <br />E.L. DISEASE- EA EMPLOYEE <br />$ 1,000,000 <br />If Ves, describe under <br />DESCRIPTION OF OPERATIONS below <br />E.L. DISEASE- POLICY LIMIT <br />1,000,000 <br />$ <br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) <br />The City of Santa Ana, its officers, officials, employees, and volunteers are hereby named as additional insured. <br />Hartford CGL policy form HG0001 includes Additional Insured status, Primary and Non -Contributory wording, and Waiver of Subrogation where required by <br />written contracts. <br />IH 0303 - 30 Day NOC applies Digitallysigned <br />CG2026—Additional Insured — Designated Person or Organization TU Tran by Tu Tran APPROVED <br />WC 990394 — 30-Day Notice of Cancellation to Certificate Holders Nguyen <br />WC040306— WC Waiver of Subrogation Nguyen Date:2025.ez2 y Tu Trait uyen at 3°17 r Feb 7, �� � <br />9 5:18:18-OB'00' <br />CERTIFICATE HOLDER CANCELLATION <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />City of Santa Ana <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />20 Civic Center Plaza <br />AUTHORIZED REPRESENTATIVE <br />Santa Ana CA 92702 <br />@ 1988-2015 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD <br />