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'4`O�Ra® CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY)
<br /> 12/3/2024
<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 /> Stephens Insurance, LLC PHONE FAX
<br /> 111 Center Street, Suite 100 IA/C.No.exu: 1-800-643-9691 (A/C,No): 501-377-2317 _
<br /> Little Rock, AR 72201 E-MAIL RESS:
<br /> INSURER(S)AFFORDING COVERAGE NAIC#
<br /> www.stephensinsurance.com INSURER A: Safety National Casualty Corporation 15105
<br /> INSURED INSURER B: Fireman's Fund Insurance Company 21873
<br /> The Patina Group Newco LLC INSURERC: National Union Fire Ins Co Pittsburgh PA 19445
<br /> c/o Patina Restaurant Group LLCg
<br /> 250 Delaware Ave INSURER D: ACE Property and Casualty Insurance Co 20699
<br /> Buffalo NY 14202 INSURER E:
<br /> INSURER F:
<br /> COVERAGES CERTIFICATE NUMBER: 82885105 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 ADDL SUBR POLICY EFF POLICY EXP
<br /> LTR TYPE OF INSURANCE INSD.WVD POLICY NUMBER
<br /> IMM/DD/YYYY)_(MM/DD/YYYYL LIMITS
<br /> A ✓ COMMERCIAL GENERAL LIABILITY GL4058709 6/27/2024 6/27/2025 EACH OCCURRENCE $1,000,000
<br /> CLAIMS-MADE ,,/ OCCUR DAMAGE TO RENTED
<br /> PREMISES(Ea occurrence) $1,000,000
<br /> MED EXP(Any one person) $Excluded
<br /> PERSONAL&ADV INJURY $1,000,000
<br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE 52,000,000
<br /> /
<br /> POLICY JECOT- ✓ LOC
<br /> PRODUCTS-COMP/OP AGG S 2,000,000
<br /> OTHER: Liquor Liability S 1,000,000
<br /> A AUTOMOBILE LIABILITY CA6675705 6/27/2024 6/27/2025 COMBINED SINGLE LIMIT $
<br /> (Ea accident) 1,000,000
<br /> / ANY AUTO BODILY INJURY(Per person) $
<br /> OWNED SCHEDULED BODILY INJURY(Per accident $
<br /> AUTOS ONLY AUTOS )
<br /> HIRED NON-OWNED PROPERTY DAMAGE
<br /> AUTOS ONLY AUTOS ONLY (Per accident) $
<br /> 1 2,000 Comp.Dell. 2,000 Coil.Ded $
<br /> B / UMBRELLA LIAB / OCCUR USC03876324U 6/27/2024 6/27/2025 EACH OCCURRENCE $10,000,000
<br /> C EXCESS LIAB CLAIMS-MADE BE 015717257 10/1/2024 10/1/2025 AGGREGATE $10,000,000
<br /> D XEU G27912904 010 10/1/2024 10/1/2025
<br /> DED RETENTIONS Excess $5,000,000
<br /> A WORKERS COMPENSATION LDS4046480 6/27/2024 6/27/2025 PER OTH-
<br /> AND EMPLOYERS'LIABILITY Y/N ✓ STATUTE ER
<br /> ANYPROPRIETOR/PARTNERJEXECUTIVE E.L.EACH ACCIDENT $1,000,000
<br /> OFFICER/MEMBER EXCLUDED? N N/A
<br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000.000
<br /> If yes,describe under
<br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT _S 1,000,000
<br /> DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
<br /> 12/10 City of Santa Ana
<br /> City of Santa Ana is included as an additional insured when in a written contract with the named insured and executed prior to a loss.
<br /> APPROVED
<br /> CERTIFICATE HOLDER CANCELLA- By Cynthia Mora at 10:29 am, Dec 04, 2024
<br /> Tangata
<br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> City of Santa Ana THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br /> 20 Civic Center Plaza ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> Santa Ana CA 92701
<br /> AUTHORIZED REPRESENTATIVE
<br /> I Stan Payne
<br /> ©1988-2015 ACORD CORPORATION. All rights reserved.
<br /> ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD
<br /> 02885105 1 24/25 Casualty Certificate Master 1 Kelly Robinson 112/3/2024 7:47(27 AM (CST) 1 sage 1 of 1
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