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John Butler <br />4a )t Illf R N c �1It()I?Nl1 Director, Corporate Risk Management <br />E D I S Q N 2244 Walnut Grove Avenue <br />Rosemead, CA 91770 <br />4rPl)f!t}\I'./ilov l.,m^Ar•. <br />CERTIFICATE OF SELF INSURANCE <br />Issued To: <br />Certificate Holder: <br />City of Santa Ana, a charter city and municipal corporation, Clerk of the City <br />Council <br />Address: <br />20 Civic Center Plaza (M-30), P.O. Box 1988 <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: Delhi Park (33.715842,-117.861320) Term: May 31, 2023 - June 30, 2025 <br />Use: Installation of stub pole and anchor <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 <br />Edison's Risk Management Department. Additional Certificate Holder Status: The Certificate Holder is <br />(a) additional insured under the general liability program[s] noted above; (b) the general liability <br />program[s] noted above are primary, and any insurance or self-insurance maintained by certificate <br />holder is excess and non-contributory; (c) waiver of subrogation applies to the general liability and <br />workers' compensation] programs note above; (d) 30-days' notice of cancellation will be provided by <br />Edison. <br />FaffeJL <br />Insurance Risk Management <br />