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® DATE(MM1DDNYYY) CERTIFICATE OF LIABILITY INSURANCE /2gf2o2s 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 NAME: Hiscox Inc.d/b/a/Hiscox Insurance Agency in CA PHI.ONE (ggg)202-3007 FAX(Pi No 5 Concourse Parkway E-MAIL Suite 2150 ADDRESS: contact@hiscox.com Atlanta GA,30328 INSURERI AFFORDING COVERAGE NAICN INSURER A: Hiscox Insurance Company Inc 10200 INSURED INSURER B Bobko Law APC INSURER C 64 Seaborough Newport Beach,CA 92660 INSURER 0, INSURER E: 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, INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LTR POLICY NUMBER MMIDDIYYYYI (MMIDDNYYYI LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,DOO CLAIMS-MADE I OCCUR PREM I. Ea occMAGE TO u ante $ 100,000 X CGL is on BOP Form MED EXP(Any one person) $ 10,000 A X X P104.053.620.1 10/25(2024 10/25/2025 PERSONAL&ADV INJURY $ 0 GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 4,000,000 X POLICY PRO- ❑ LOC .1F(:T PRODUCTS-COMPlOP AGG $ 4,000,000 OTHER $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per Person) $ ALL OWNED 5C HEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per arrdent' UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS LIABILITY Y/N STATUTE ER ANYPROPRIETORIPARTNERIEXECUTIVE ❑ N 1 A E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 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 requiredl City of Santa Ana, its City Council, officers, officials, employees,agents, and volunteers are to be covered as additional insureds with respect to General Liability coverage for liability arising out of work operations performed by or on behalf of Contractor including materials, parts, and equipment furnished in connection with such work or operations as provided by the general liability policy form. Cancellation notices will be provided as stated in the general liability policy form.Coverage is Primary and Non-Contributory.Waiver of subrogation applies. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Santa Ana hs1e ecse1Pier °s°° THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN a`` CityAttOrney'sOffiCe ,dy"pp—�d°; ACCORDANCE WITH THE POLICY PROVISIONS. oPIPy, V4'<21U l�GNrt6lroR� 20 Civic Center Plaza Santa Ana,CA92702 �_, AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD