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Digitally signed by Tort Pierson Tori Pierson Date:3032.05.1110:07:13 DT 00 ACOR& CERTIFICATE OF LIABILITY INSURANCE DAM(MM/DDNYYY) 04/29/2022 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 CONTACT NAME: Hiscox Inc. d/b/a/ Hiscox Insurance Agency in CA 5 Concourse Parkway Suite 2150 PRON o Ea . (888) 202-3007 FAX E-MAIL ADDREss: conlact@hiscox.com INSURERS AFFORDING COVERAGE NAICk Atlanta GA, 30328 INSURERA: Hiscox Insurance Company Inc 10200 INSURED J. Smith & T. Mull, Inc. DBA Infrastructure Engineering Group 33161 Camino Capistrano INSURER B : INSURER C: INSURER D : D INSURER E: San Juan Capistrano, CA 92675 INSURER F COVERAGES CERTIFICATE NUMBER: RFVIs1nN NNMRFR- 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 ADDLSUBR POLICY NUMBER POLICY EFF MMIDD/YYYY POLICY UP MMIDO LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE I -XI OCCUR Y UDC-5151630-CGL-22 04/29/2022 04/29/2023 EACH OCCURRENCE $ 1,000,000 DAMAGE RENTED PREMISES Ea occurrence $ 100,000 X GEN'L X MED UP (Any one person) $ 5,000 I Primary &Noncontdbutory PERSONAL&ADV INJURY $ 1,000,000 AGGREGATE LIMIT APPLIES PER POLICY 0 ;EC'T LOG OTHER: GENERALAGGREGATE $2,000,000 PRODUCTS-COMP/OPAGG s SIT Gen. Agg $ AUTOMOBILELIABILDY ANYAUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED X NON -OWNED AUTOS ONLY AUTOS ONLY UDC-5151630-CGL-22 04/29/2022 04/29/2023 COMBINED SINGLELIMIT Ea eodd.rd $ X BODILY INJURY (Per person) $ BODILY INJURY (Par accident) $ PROPERTY DAMAGE Per accident $ CGL HNOA Limit (car occur rence $ 1,000,000 UMSRELLAUAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANYPROPRIETOR/PARTNEWEXECUTWE OFFICE(Mandatory InN RE%CLUDEDI (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N/A PER OTH- STATUTE ER E.L. EACH ACCIDENT $ E.L. DISEASE -EA EMPLOYEE $ E.L. DISEASE -POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101. Additional Remarks Schedule, may be attached if more space is required) The City of Santa Ana, its officers, employees, agents, volunteers and representatives as additional insured (a), and is primary on non-contributory Management Division 20 Civic Center Plaza Santa Ana CA 92702 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. ©1988-2015 ACORD CI ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD