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AC o® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) `------ 07/23/2024 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: the certificate holder is ar ADDITIONAL INSURED,the policy( s)m e D I 6 n b n eIf SUBROGA IS WAIVED,sub'ect to a terms and conditions of the polit: r,ne ,By iital nd I nt n� this certific s n er t c to holder in lieu of such e ,dorsemen s PRODUCER Ct 1 FACT Stephen Roth NA E: ,tp�1�►�7�Corona Insur a Age y _IA,do Y Y I ,2�7Aceved 2275 S Main St#101 C E DF S : h p INSURER(S)AFFORDING COVERAGE NAIC# Corona CA 2882 IIVSURER� hV@ it I nc Cpar C 18058 INSURED INSI1.7, • ••• • • J Aceve INSURER C: /�INSURERC2:22 07100. 1010 N.M •4 INSURER J SANTA ANA CA 92-J 1 INSURER F: COVERAGES CERTIFICATE NUMBER: CL2462749481 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. INSR AWL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS x COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED CLAIMS-MADE OCCUR PREMISES(Ea occurrence) $ 100'000 MED EXP(Any one person) $ 5,000 A Y Y PHPK2571348022 07/01/2024 07/01/2025 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 3'000,000 -H POLICY n PRO- 1'000,000 I 'JECT LOC PRODUCTS AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) X ANY AUTO BODILY INJURY(Per person) $ A OWNED SCHEDULED PHPK2571348022 07/01/2024 07/01/2025 BODILY INJURY(Per accident) $ AUTOS ONLY _ AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY (Per accident) _ Medical payments $ 5,000 UMBRELLA LIAB - OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER B ANY PROPRIETOR/PARTNERJEXECUTIVE Y7 N!A 72WEBG4U1B 07/01/2024 07/01/2025 E.L.EACH ACCIDENT $ 1000000 OFFICERJMEMBER EXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 1000000 If yes,describe under 1000000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ _ Sexual/Abuse/Molestatio $2,000,000 General Liability A PHPK2571348022 07/01/2024 07/01/2025 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) [Job#: Job Type:RE:USE OF 10TH ST.] 10 DAYS NOTICE OF CANCELLATION FOR NON-PAYMENT OF PREMIUM.THE CITY,ITS OFFICERS,OFFICIALS,EMPLOYEES,AGENTS,AND VOLUNTEERS ARE NAMED AS ADDITIONAL INSURED PER THE ATTACHED PL-GLD-VS(05/17)INCLUDES PRIMARY&WAIVER. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN City of Santa Ana ACCORDANCE WITH THE POLICY PRO)\ 1 o ^, Riak Management D ivis[on 20 Civic Center Plaza -tee REVIEWED&APPROVED BY: t AUTHORIZED REPRESENTATIVE o! Santa Ana CA 92701 / `. A+P A I -i.4.''` ;l.'• �' Risk Management Specialist ©1988-2015 ACOF/ ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD