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.r1 A6. _ CERTIFICATE OF LIABILITY INSURANCE DATE (M8/2024YYY) 08/28/2024 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 Maguire Insurance Agency,Inc.FWI NAME: 1 Bala Piz Ste 100 PHONE FAX Bala Cynwyd,PA 19004-1401 (AIC,No,Ext): (AIC,No): 610.617.7900 E-VAN,• • • A DR INSURE S)AFFO G COVERAGE NAIC# INS ERA: PMladelphia demnitylnsuranceCo an 18058 INSURED Dennys Diaz 7143 Fulton Way i,'SURER C: Stanton,CA 90680 IN � } • ` • • • iN E t(C P Nit P . IN F COVERAG CE IC U .: — SIW UMBER: 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. INSR ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DDIYYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY X X PHPK2457612-002 09/01/2024 09/01/2025 EACH OCCURRENCE $1,000,000 CLAIMS-MADE ❑X OCCUR DAMAGE TO RENTED PREMISES(Ea occurrence) $100,000 X PROFESSIONAL LIABILITY MED EXP(Any one person) $2,500 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $3,000,000 X POLICY ❑PROJECT ❑LOC PRODUCTS-COMP/OP AGG $3,000,000 OTHER SAM AGGREGATE $300,000 SAM OCCURENCE $100,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ ANY AUTO BODILY INJURY(Per person) $ OWNED AUTOS SCHEDULED AUTOS ONLY BODILY INJURY(Per accident) $ HIRED AUTOS NON-OWNED PROPERTY DAMAGE ONLY AUTOS ONLY (Per accident) $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION PER OTHER AND EMPLOYERS'LIABILITY Y/N STATUTE ANYPROPRIETOR/PARTNER/EXECUTIVE N/A OFFICER/MEMBER EXCLUDED? E.L.EACH ACCIDENT $ (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ I I DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) It is understood and agreed that the following entity is added as an additional insured but only with respect(s)to the operations of the named insured except that liability resulting from the additional insured's sole negligence. The City of Santa Ana,its officers,officials,employees and volunteers are covered as additional insureds on the CGL policy with respect to liability arising out of work or operations performed by or on behalf of the Permitee including materials,parts,or equipment furnished in connection with such work operations. CERTIFICATE HOLDER CANCELLATION City of Santa Ana Risk Management Division SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE 20 Civic Center Piz EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH Santa Ana,CA 92701 27 THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Risk ManagmentDMsLcrn �?- REVIEWED&APPROVED BY: ® Risk Management Specialist ©1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD