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ACCPRO CERTIFICATE OF LIABILITY INSURANCE 7DATE(/5/202ttYYY) 3 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(les)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 CON IACI NAME: Western Republic Insurance Services ( IC NNo,Ext): 714,536.0500 (A/C,No): 19900 Beach Blvd ADMRIL dustin rinsurance.com ADDRESS: (diw' Suite Ft INSURER(S)AFFORDING COVERAGE NAIC# Huntington Beach CA 92648 INSURERA: BERICLEY ASSURANCE CO 39462 INSURED INSURER e: STATE COMPENSATION INS 35076 J&L Constructors Inc INSURER C: 29104 Basswood INSURER D INSURER E: Lake Elsinore CA 92530 INSURER F: COVERAGES CERTIFICATE NUMBER: 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 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. INSN AUUL SUER' POLICY El-I- POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER IMM/DD/YYYY) (MM/DOIYYYY) LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR PREMISES(Es occurrence) $ 100,000 MED EXP(Any one person) $ 5,000 A Y Y VUMA0310930 04/27/2023 04/27/2024 PERSONAL B ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 PRO- X POLICY JECT LOC PRODUCTS-COMP/OP AGO $ 2,000,000 OTHER: AUTOMOBILE LIABILITY COMBINE°SINGLE LIMI I $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ —OWNED —SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS —HIRED —NON-OWNED PROPER I YDAMAGE AUTOS ONLY _AUTOS ONLY (Per accident) UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000 A X-EXCESS LIAB CLAIMS-MADE VUMA0310940 04/27/2023 04/27/2024 AGGREGATE $ 5,000,000 BED RETENTION$ $ WORKERS COMPENSATION PER OIH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY B OFFICER/MEMBER EXCLUDED?EcunvE N/A Y 9170623-22 12/03/2023 12/03/2024 E.L.EACH ACCIDENT $ 1,000,000 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) Those usual to the insured's operations.The certificate is named as additional insured per the attached MEGL 0009-01 09 18.Waiver of subrogation applies per the attached CG 24 04 12 19 and 10217(REV.4-2018).A 30-day written notice of cancellation is applicable.A 30-day written notice of cancellation is applicable. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Orange County Fire Authority ACCORDANCE WITH THE POLICY PROVISIONS. 1 Fire Authority Road AUTHORIZED REPRESENTATIVE Irvine,CA 92602 Dwyltw Kne ty ©1986-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD