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John Butler <br />�11 It IIII It N ( \t If t WNI r► Director, Corporate Risk Management <br />E D I S O N� P. o. Box 800 <br />:2244 Walnut <br />Grove Avenue <br />Rosemead, CA 91770 <br />CERTIFICATE OF SELF INSURANCE <br />�110 <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: 124 E. Warner Ave (33.715825,-117.8668281) Term: June 21, 2023 - June 30, 2025 Use: <br />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 Edison's Risk <br />Management Department. Additional Certificate Holder Status: The Certificate Holder is (a) additional insured <br />under the general liability program[s] noted above; (b) the general liability program[s] noted above are primary, <br />and any insurance or self-insurance maintained by certificate holder is excess and non-contributory; (c) waiver of <br />subrogation applies to the general liability and workers' compensation] programs note above; (d) 30-days' notice <br />of cancellation will be provided by Edison. <br />M 601*b <br />Insurance Risk Management <br />