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CERTIFICATE OF LIABILITY INSURANCE <br />DATE (MMIDOIYYYY) <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 endomementfsl. <br />PRODUCER <br />wY ci <br />rl <br />Venbrook Insurance Services <br />Di <br />FAx <br />16815 Von Karman Ave • <br />Irvine 180 Angie <br />L. <br />c Ne E : <br />o uc No: <br />94s-652-39BO <br />n L <br />certficates venbrpok.Com <br />Irvine, CA 92606 <br />AJ <br />mslm AFFaRomscovERAeE <br />Naca <br />www.venbrook.com C <br />o. OD80832 <br />I <br />velers Casual <br />Insurance Cc of America <br />19046 <br />INSURED <br />Monument ROW <br />I u <br />elem Property <br />Casualty Co of America <br />25674 <br />200 <br />Irvine <br />Spectrum Center, <br />CA 92618 Acevedo <br />o <br />ri <br />of London <br />15642 <br />11512 <br />COVERAGES <br />CERTIFICATE NUMBER: 79779905 <br />REVISION NUMBER: <br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW RAVE 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 <br />LTR <br />TYPE OF INSURANCE <br />ADDL <br />SUBR <br />POUCYNUMBER <br />POLICY EFF <br />M DDNYYY) <br />POLICY EXP <br />(MWDDNYYYI <br />LIMITS <br />A <br />✓ <br />COMMERCIAL GENERAL LIABILITY <br />✓ <br />✓ <br />6807P4562802442 <br />4/2312024 <br />4/23/2025 <br />EACH OCCURRENCE <br />$1.000,000 <br />CLAIMS -MADE 1J OCCUR <br />OHMAGE TO <br />PREMISES Eao vnence <br />$300,000 <br />MED EXP(My one person) <br />$5,000 <br />✓ <br />Deductible: none <br />PERSONALSADVINJURY <br />$1.000,000 <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />GENERALAGGREGATE <br />$2,000,000 <br />✓ POLICY � JET n LOC <br />PRODUCTS-COMPfOPAGG <br />$2000000 <br />$ <br />OTHEk <br />A <br />AUTOMOBILEMBILITY <br />6807P4562802442 <br />4/23/2024 <br />4/23/2025 <br />aBINNED SINGLE LIMIT <br />$1000000 <br />BODILY INJURY (Per person) <br />$ <br />ANYAUTO <br />OWNED SCHEDULED <br />AUTOS ONLY AUTOS <br />BODILY INJURY (Pera x ident) <br />$ <br />✓ <br />HIRED NE <br />AUTOS ONLY ✓ AUTOS ONLY <br />(ParraaEAnOAMAGE <br />$ <br />$ <br />8 <br />ri <br />UNBRELIA LU\B <br />✓ <br />OCCUR <br />CUP5N8889392442 <br />4/23/2024 <br />4/23/2025 <br />EACH OCCURRENCE <br />$5000,000 <br />AGGREGATE <br />$5000,000 <br />IXCE55lJAB <br />CLAIMS -MADE <br />DEO I ✓ I RETENTION$0 <br />$ <br />B <br />WORKERS COMPENSATION <br />AND EMPLOYERW LIABILITY YIN <br />OFFILE PRJE EREXCLUDED ECUTIVE � <br />NIA <br />✓ <br />UB2Y3528922442G <br />4/23(2024 <br />4123/2025 <br />✓ STartrrE °Erz <br />E.L. EACH ACCIDENT <br />' <br />$1000000 <br />EL DISEASE -EA EMPLOYE <br />$1 QS10 000 <br />-" - <br />(Mandatory In NH) <br />Ryyeess,, describe under <br />OESCRIPTION OF OPERATIONS below <br />EL DISEASE -POLICY LIMIT <br />$1 000 000 <br />C <br />Professional Liability (Claims Made <br />MPL444730524 <br />4/23/2024 <br />4123/2025 <br />$2,000,000 Each Claim/ Aggregate Limit <br />& Reported) <br />Retention: $5,000 Each Claim <br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, maybe aHached itmore space Is required) <br />RE: The City of Santa Ana, its officers, employees, agents, and representatives are named as Additional Insured in respects General Liability <br />perform CGD105 0494. Primary/Non-Contributory form CGT1000219, Waiver of Subrogation form CGD842 0219, WC040306 4-84 applies in favor of the <br />Additional Insured when required by written contract. 30 Day Notice of Cancellation per policy provisions. Subject to policy terms, conditions <br />and exclusions. <br />City Of Santa Ana <br />Risk Management Division <br />20 Civic Center Plaza, 4th Floor <br />Santa Ana CA 92701 <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE <br />THE EXPIRATION DATE THEREOF NnTIP.F wu I <br />ACCORDANCEWITH THE POLICY PRL <br />4UTHORVEDREPRESENTATME <br />I <br />Gabriela Covarrubias <br />©1988-2015 ACORD <br />RF nF1 nIFRFn IN <br />.,yam <br />y .'te. <br />�' ' ] <br />111aleMMugoarnlD[uiefan <br />REVIEWED&APPRcIW®Br <br />✓�'N�s=flr.Wflta <br />J <br />Risk Management spedalm <br />00 <br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD <br />7EleB9D- 2021 G , HNUS, S, WC, EL Gabriela C - s 1 4/30/2024 1-02:02 PM (FCTI I Page I of 8 <br />This certificate cancels and supersedes ALL previonslp issued certificates, <br />