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John Butler <br />mmiY it I I I[ 12 N ( 1l II ( )ItNI It Director, Corporate Risk Management <br />E D I S O N 2244 Walnut Grove Avenue <br />Rosemead, CA 91770 <br />(nI01t %t%tIN%07U' <br />CERTIFICATE OF SELF INSURANCE <br />Issued To: <br />Certificate Holder: <br />City of Santa Ana, a charter city and Municipal Corporation <br />Address: <br />Clerk of the City Council, City of Santa Ana <br />20 Civic Center Plaza (M-30) <br />City: <br />Santa Ana <br />State: <br />CA <br />Zip Code <br />92702-1988 <br />The self-insurance programs listed below are in force with regard to the following: <br />Loc: 705 E. Warner Ave. (APN 016-103-23) Term: Feb. 13 - Jun. 30, 2023 Use: Construction <br />Laydown Yard to store vehicles, materials, and other construction equipment. <br />Type of Self -Insurance <br />Program <br />Policy <br />No. <br />Policy Period <br />Limits of Liability <br />Commercial <br />Self- <br />Continuous <br />$1 Million per Occurrence & <br />General Liability <br />Insured <br />$2 Million Aggregate <br />(Includes Auto Liability) <br />for Bodily Injury & Property Damage <br />Workers' Compensation <br />Self- <br />Continuous <br />Statutory (WC) <br />& Employer's Liability <br />Insured <br />$1 Million (EL) Aggregate <br />This certificate is not valid unless signed by an authorized representative of Southern California Edison's <br />Risk Management Department. Additional Certificate Holder Status: The Certificate Holder is (a) <br />additional insured under the general liability program[s] noted above; (b) the general liability program[s] <br />noted above are primary, and any insurance or self-insurance maintained by certificate holder is excess <br />and non-contributory; (c) waiver of subrogation applies to the [general liability and workers' <br />compensation] programs note above; (d) 30-days' notice of cancellation will be provided by Edison. <br />Insurance Risk Management <br />