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ACORO® CERTIFICATE OF LIABILITY INSURANCE DATE(MMIODIYYYY) 1 111 07/15/2022 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 Lauren Justus NAME: Turner, Wood,&Smith Agency, Inc. PA HONENo ( (770)536-0161 FAX 770) 536-1283 Ext: A/C No : 1515 Community Way E-MAIL lauren.justus@twsinsurance.com ADDRESS: PO Box 1058 INSURER(S) AFFORDING COVERAGE NAIC g Gainesville GA 30503 INSURER A: Accident Fund Insurance Company of America 10166 INSURED INSURER B: United States Liability Insurance Company 25895 Stand Up For Kids INSURER C: 200 Nelson Ferry Rd INSURER D : Ste 6 INSURER E: Decatur GA 30030 INSURER F: COVERAGES CERTIFICATE NUMBER: CL2252728855 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE 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 Lm TYPE OF INSURANCE INSD MD POLICY NUMBER POLICY MMIDDIYYYY POLICY EXP MMIDONYYY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ PREMISES Ea orom,ence $ CLAIMS -MADE 0OCCUR MED EXP(Any one person) $ PERSONAL &ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: POLICY 0 PRO- JECT LOC GENERALAGGREGATE $ PRODUCTS-COMP/OPAGG $ $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea aokkant $ BODILY INJURY (Per person) $ ANY AUTO OWNED SCHEDULED AUTOS ONLY BODILY INJURY Per amitlent) $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE Per accident) $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAR CLAIMS -MADE DEO I I RETENTION $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNEWEXECUTIVE Y� OFFICERIMEMBER EXCLUDED? (Mandatory in NH) If yes, DESCRIPTION antler DESCRIPTION under OPERATIONS below NIA Y WCP100031316 O6/27/2022 06/27I2023 v PER OTH- X STATUTE ER E.L. EACH ACCIDENT $ 1.000,000 E.L. DISEASE -EA EMPLOYEE S 1,000,000 E.L. DISEASE -POLICY OMIT 1,000,000 $ B Directors 8 Officers Liability Y ND01562548H 05/18/2022 05/18/2023 Each Claim Aggregate 1,000,000 1,000,000 Retention -Each Claim 5,000 DESCRIPTION OF OPERATIONS LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required) Blanket WES is included per form WC000313. 30-Days Notice of Cancellation, except for Non -Payment which is 10-Days Notice. City of Santa Ana Risk Management Division 20 Civic Center Plaza Santa Ana SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE w MnagmmdDiNabn CA 92702 +urzrLif, `I ' 7ev;%m as lJ lSaa-ZUID ACVKU - ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD