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CERTIFICATE OF LIABILITY INSURANCE <br />DATE(MMIDD/YYYY) <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 <br />VenbLI I f <br />enbrooklnsuranceServices DIr•DD <br />16815 Von Karman Avery • G N o . FAX No, <br />94s 65z 396Q <br />SUjne 1C /� n b A IL certificates@verbrook.com <br />Irvine, CA 92606 �\ L! INSURERS AFFORDING GO4ERAGE NAM:g <br />wwwmenbrook.com CArLldlA I e o. OD80832 1 a veterS Casualty Insurance Co of America 19046 <br />INSURED D ele€s Property ert Casual Co of America 25674 <br />Monument ROW R L of London t642 <br />200 Spectrum Center, Acevedo 1 . <br />Irvine CA 92618 1562 <br />COVERAGES <br />_ 0 <br />CERTIFICATE NUMBER: 7gT74gn5 <br />RFVLCInN NIt"RCR. <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 />LTR <br />TYPE OF INSURANCE <br />ADOL <br />SUER <br />POLICY NUMBER <br />MMNDY EFF <br />MP IDY <br />LIMBS <br />A <br />j <br />COMMERCLALGENERAL UABIUTY <br />CLAIMS -MADE OCCUR <br />j <br />j <br />6807P4562802442 <br />4/23/2024 <br />4/23/2025 <br />$1,000.000 <br />EE TO aoccunence <br />$3Q0Q00 <br />rEAC1URRENCE <br />Any one person) <br />$5,000 <br />Deductible: none <br />L&ADV INJURY <br />$1.000 000 <br />✓ <br />AGGREGATE LIMIT APPLIES PER <br />POLICY❑jECT �LOC <br />AGGREGATE <br />$2,000,000 <br />GEN'L <br />✓ <br />S-COMPIOP or <br />$2000000 <br />$ <br />OTHER: <br />A <br />AUTOMOBILELMBILRY <br />6807P4562802442 <br />4/2312024 <br />4/23/2025 <br />Ea awdeotSINGLE LI T <br />$100000o <br />ANY AUTO <br />BODILY INJURY Pet Pe wn) <br />I <br />AWNED SCHEDULED <br />AUTOS ONLY AUTOS <br />HIRED <br />AUTOS ONLY ✓ AUOS ONLDY <br />BADILY INJURY (Per aaitleni) <br />$ <br />PRQPERTY DAMAGE <br />Per accitlenl <br />$ <br />B <br />f <br />IMERELLALIAe <br />j <br />OCCUR <br />CUPSN8869392442 <br />4/23/2024 <br />4/23/2025 <br />EACH OCCURRENCE <br />$5,000,000 <br />AGGREGATE <br />$S QQQ,000 <br />EXCESS LIAR <br />CLAIMSMADE <br />DED ✓ RETENTIO100 <br />$ <br />B <br />WORKERSCOMPENSATION <br />AND EMPLOYERS' LIABILITY Y / N <br />ANYPROPRIETORIPARTNERIEXECUTIVE <br />OFFICERIMEMBEREXCLUDEO? Y❑ <br />NIA <br />j <br />UB2Y3528922442G <br />4/23/2024 <br />4/23/2025 <br />PER AT <br />✓ STATUTE ER <br />A. <br />EEACH ACCIDENT <br />$i,000 OOQ <br />E.A. DISEASE -EA EMPLOYEE <br />- <br />$1.000 QQ <br />(Mandatory in NH) <br />Ryes, describe under <br />rr <br />$1000000 <br />DESCRIPPONOFOPERATIONS be. <br />IE.L.OISEASE-POLICYLIMIT <br />C <br />Professional Liability (Claims Made <br />& Reported) <br />MPL444730524 <br />4/23/2024 <br />4123/2025 <br />$2,000,000 Each Claim/ Aggregate Limit <br />Retention: $5,000 Each Claim <br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 10t, Additional Remarks Schedule, may be attached if more 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 />per form 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 />[N�:illy[N_\Iq <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 CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF NOTIrx WD I RF nF1 IVFRFn m <br />ACCORDANCE WITH THE POLICY PRC <br />AUTHORIZED REPRESENTATIVE <br />ACORD <br />Risk MtmagaturdDifislan <br />REVIEWED&APPROV®BY. <br />A u ^ ' <br />®' <br />Risk Management Specarast <br />ACORD 25 (2016/03) <br />The ACORD name and logo are registered marks of ACORD <br />79779905 2024 GL, Run, UtIB, WC, FL Gabiiala C• aziubias 1 4/30/2024 1:C2:01 P41 (PDT) I Page 1 sf 3 <br />This certificate cancels and supersedes ALL previously issued certificates. <br />