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CERTIFICATE OF LIABILITY INSURANCE DATE (MMMD/YYYY) 02/26/2025 THIS CERTIFICATE 15 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 be endorsed. If SUBROGATIONIS 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: AUTOMATIC DATA PROCESSING INS AGCY 76250717 71 HANOVER ROAD FLORHAM PARK NJ 07932 PHONE (800) 524-7024 (A/C, No, Fax (A/C, No): ESS: E-MAILADDRESS: INSURER(3) AFFORDING COVERAGE NAICk INSURER A: Hartford Fire and Its P&C Affiliates 00914 INSURED INSURER B JACOB GREEN AND ASSOCIATES INC. INSURER c 13217 JAMBOREE RD If 248 INSURER 0: TUSTIN CA 92782-9158 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 R TYPE OF INSURANCE ADDL INSR SUBR WID POLICY NUMBER POLICY EFF MMIDD/YYYV POLICY UP MMIDD V V LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE CLAIMS -MADE ❑OCCUR DAMAGE TO RENTED PR�MISES Ea occurrence MED EXP (Any one person) PERSONAL &ADV INJURY GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE POLICY❑PRO- ❑LOC ECT PRODUCTS - COMP/OPAGG OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accitlenl BODILY INJURY (Per person) ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accitlent) HIRED NON -OWNED PROPERTY DAMAGE AUTOS AUTOS (Peraxldent) UMBRELLA LIAB EACH OCCURRENCE EXCESS LIAB HOCCUR CLAIM& MADE AGGREGATE OEO RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY X PER STATUTE OTH- ER E.L. EACH ACCIDENT $1,000,000 ANY YIN A PROPRIETORIPARTNERJEXECUTIVE OFFICER/MEMBER EXCLUDED? NIA X 76 WEG AS7GJL 05l24l2024 05l24l2025 E.L. DISEASE -EA EMPLOYEE $1,000,000 (Mandatory in NH) If yes, describe under E.L. DISEASE -POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Those usual to the Insured's Operations. CERTIFICATE HOLDER CANCELLATION City Of Santa Ana SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED Attention: Human Resources - Lori Schna BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED 20 CIVIC CENTER PLZ # M-24 FL 5 IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE SANTA ANA CA 92701-4058 © 1988.2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD APPROVED By Tu Tran Nguyen. at 10:57 am, Mar 03, 2025