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Ejhjubmmz!tjhofe! DATE (MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE cz!Bohjf! 06/14/2022 Bohjf! THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS Bdfwfep! 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 Ebuf;!3133/17/27! REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. Bdfwfep IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. 28;19;67!.18(11( 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). CONTACT PRODUCER Han Shi NAME: FAX PHONE Eversafe Insurance Agency, Inc.(626) 821-4900(626) 821-4907 (A/C, No): (A/C, No, Ext): E-MAIL 10508 Lower Azusa Rdhan.shi@eversafeins.com ADDRESS: Suite 202 INSURER(S) AFFORDING COVERAGENAIC # El MonteCA91731Penn Star Insurance Company INSURER A : INSURED INSURER B : Haz Rental Center LLCOhio Security Insurance Company INSURER C : 8642 Garden Grove Blvd INSURER D : INSURER E : Garden GroveCA92844 INSURER F : COVERAGESCERTIFICATE 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. ADDLSUBR INSRPOLICY EFFPOLICY EXP TYPE OF INSURANCELIMITS POLICY NUMBER LTR(MM/DD/YYYY)(MM/DD/YYYY) INSDWVD COMMERCIAL GENERAL LIABILITY 1,000,000.00 EACH OCCURRENCE$ DAMAGE TO RENTED 100,000.00 CLAIMS-MADEOCCUR$ PREMISES (Ea occurrence) 5,000.00 MED EXP (Any one person)$ AYYCPV003280302/10/202202/10/20231,000,000.00 PERSONAL & ADV INJURY$ 2,000,000.00 GEN'L AGGREGATE LIMIT APPLIES PER:GENERAL AGGREGATE$ PRO- 2,000,000.00 POLICYLOCPRODUCTS - COMP/OP AGG$ JECT $ OTHER: COMBINED SINGLE LIMIT AUTOMOBILE LIABILITY$ (Ea accident) ANY AUTO BODILY INJURY (Per person)$ OWNEDSCHEDULED BODILY INJURY (Per accident)$ AUTOS ONLYAUTOS NON-OWNED HIREDPROPERTY DAMAGE $ (Per accident) AUTOS ONLYAUTOS ONLY $ UMBRELLA LIAB EACH OCCURRENCE$ OCCUR EXCESS LIAB CLAIMS-MADEAGGREGATE$ $ DEDRETENTION$ PEROTH- WORKERS COMPENSATION STATUTEER AND EMPLOYERS' LIABILITY Y / N 1,000,000.00 ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT$ N / A CYXWS6261822502/10/202202/10/2023 OFFICER/MEMBER EXCLUDED? 1,000,000.00 (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE$ If yes, describe under 1,000,000.00 E.L. DISEASE - POLICY LIMIT$ DESCRIPTION OF OPERATIONS below Limit$240,000 Equipment Floater ACPV003280302/10/202202/10/2023Deductible$1,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) City of Santa Ana Risk Management, its officers, officials, employees, and volunteers are included as additional insureds Waiver of subrogation endorsement included Primary and non-contributory endorsement included CERTIFICATE HOLDERCANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Santa Ana Risk Management AUTHORIZED REPRESENTATIVE 20 Civic Center Plaza Santa AnaCA92701 © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03)The ACORD name and logo are registered marks of ACORD