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Docusign Envelope ID: E0A64A9A-03B0-4CEE-A16A-835A05595EAC <br /> This Qualified Assignment and Release Agreement is signed in one or more counterparts as of the Effective <br /> Date by the following: <br /> Assignor(1): _Berkley Public Entity-Gemini Insurance Company <br /> By: <br /> Authorized Representative(s) <br /> Title: <br /> Assignor(2): The City of Santa Ana <br /> By: <br /> Authorized Representative(s) <br /> Alvaro Nunez Al -ST: <br /> Title: City Manager <br /> •hT, <br /> Jennifer . H8I <br /> 111-4"iM1,,ILA <br /> eri( p. <br /> Assignee: Pacific Life &Annuity Services, Inc. Assignee: Pacific Life & Annuity Services, Inc. <br /> By: By: <br /> Authorized Representative Authorized Representative <br /> Title: Title: <br /> Claimant(s): Delilah Guerrero, a minor, by and through her guardian ad litern, Cristina Lopez <br /> By: II <br /> Approved as to Form and Co <br /> 72' <br /> Claiman ' Attorney <br /> PL QAR Page 6 of 6 v2023 <br />