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(MMI <br /> A�® CERTIFICATE OF LIABILITY INSURANCE 7OT4 <br /> 6/202 DIYYYY) <br /> 6/20 2 5 <br /> THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS <br /> CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES <br /> BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED <br /> REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. <br /> IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. <br /> If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on <br /> this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). <br /> PRODUCER CONTACT <br /> Marsh Risk&Insurance Services NAME: <br /> PHONE FAX <br /> 17901 Von Karman Avenue,Suite 1100 (A/C,No Ext: A/C,No): <br /> (949)399-5800;License#0437153 E-MAIL <br /> Irvine,CA 92614 ADDRESS: <br /> Attn:NewportBeach.CertRequest@marsh.com/F:212-948-4323 INSURER(S)AFFORDING COVERAGE NAIC# <br /> CN102166416-STND-GAWUP-25- INSURERA: Hartford Fire Insurance Company 19682 <br /> INSURED INSURER B: N/A N/A <br /> Griswold Industries,Cla-Val Company <br /> 1701 Placentia Avenue INSURER C: Twin City Fire Insurance Company 29459 <br /> Costa Mesa,CA 92627-4475 INSURER D: NIA N/A <br /> INSURER E: Hartford Fire Insurance Company 19682 <br /> INSURER F: <br /> COVERAGES CERTIFICATE NUMBER: LOS-002267646-39 REVISION NUMBER: <br /> THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD <br /> INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br /> CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br /> EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br /> INSR ADDLSUBRTYPE OF INSURANCE INSD WVD POLICY NUMBER <br /> POLICY EFF POLICY EXP <br /> LTR MM/DDIYYYYI iMMIDDIYYYYI LIMITS <br /> A X COMMERCIAL GENERAL LIABILITY 72ECSOFOBP5 04/01/2025 04/01/2026 EACH OCCURRENCE $ 1,000,000 <br /> RENTEDDAMAGE TO <br /> CLAIMS-MADE X� OCCUR FIR SES Ea occurre... $ 300,000 <br /> X $1,000,000 SIR MED EXP(Any one person) $ <br /> PERSONAL&ADV INJURY $ 1,000,000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 <br /> POLICY❑ JECT PRO ❑ LOC PRODUCTS-COMP/OPAGG $ 2,000,N <br /> 000 <br /> OTHER: $ <br /> A AUTOMOBILE LIABILITY 72UENUM3154 04/01/2025 04/01/2026 COMBINED SINGLE LIMIT $ 1,000,000 <br /> Ea accident <br /> X ANY AUTO BODILY INJURY(Per person) $ <br /> OWNED SCHEDULED BODILY INJURY(Per accident) $ <br /> AUTOS ONLY AUTOS <br /> HIRED NON-OWNED PROPERTYDAMAGE <br /> X AUTOS ONLY L <br /> AUTOS ONLY Per accident) $ <br /> UMBRELLALIAB OCCUR EACH OCCURRENCE $ <br /> EXCESS LIAB CLAIMS-MADE AGGREGATE $ <br /> DED RETENTION$ $ <br /> E WORKERS COMPENSATION 72WNC931 00(CA) 04/01/2025 04/01/2026 X PER OTH- <br /> AND EMPLOYERS'LIABILITY STATUTE ER <br /> C YIN 72WEHO3564 AOS 04/01/2025 04/01/2026 1,000,000 <br /> ANYPROPRIETOR/PARTNER/EXECUTIVE ( ) E.L.EACH ACCIDENT $ <br /> OFFICER/MEMBER EXCLUDED? N❑ NIA <br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 <br /> If yes,describe under 1,000,000 <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ <br /> DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) <br /> The City of Santa Ana,its officers,employees,agents,and representatives are included as additional insured(except workers'compensation)where required by written contract. <br /> Digitally signed <br /> TU Troll an Nguyen N APPROVED <br /> Nguyen <br /> Nguyen Dat 1:02-0.7'00' By Tu Tran Nguyen at 11:50 am,Apr 23,2025 <br /> 11:51:02-0T00' <br /> CERTIFICATE HOLDER CANCELLATION <br /> City of Santa Ana SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> Attn:Heidi Chou(M-85) THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> 215 S.Center St. ACCORDANCE WITH THE POLICY PROVISIONS. <br /> Santa Ana,CA 92703 <br /> AUTHORIZED REPRESENTATIVE <br /> of Marsh Risk&Insurance Services <br /> @ 1988-2016 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD <br />