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CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) <br /> 1/27/2025 <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 /> Inszone Insurance Services, LLC NAME: Certificate Team <br /> AX <br /> 2721 Citrus Road, Suite A PWC.HONNo,E rxt).877-308-9663 VC He),916-400-2625 <br /> Rancho Cordova CA 95742 E-MAIL certs@inszoneins.com <br /> INSURERS AFFORDING COVERAGE NAIC# <br /> License#:DF82764 INSURER A:West American Insurance Company 44393 <br /> INSURED INTEING-15 INSURER B:Ohio Security Insurance Company 24082 <br /> Inter-Pacific Inc. <br /> 39 Peters Canyon Road INSURER C:Security National Insurance CompanV 19879 <br /> Irvine CA 92606 INSURERD: <br /> INSURER E <br /> INSURER F: <br /> COVERAGES CERTIFICATE NUMBER:2053790649 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 /> TYPE OF INSURANCE LTR POLICYNUMBER MM1DD[YYYY) (MMfDDffYYYI LIMITS <br /> A X COMMERCIAL GENERAL LIABILITY Y BKW(25)62 69 89 05 918/2024 9/8/2025 EACH OCCURRENCE $1,000,000 <br /> DAMAGE TO RENTED <br /> CLAIMS-MADE X OCCUR PREMISES Ea occurrence $500,000 <br /> MED EXP(Any one person) $15,000 <br /> PERSONAL 8 ADV INJURY S 1,000,000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 <br /> X POLICY PRO- ❑ <br /> JECT TOO PRODUCTS-COMPIOP AGG $2,000,000 <br /> OTHER: $ <br /> B AUTOMOBILE LIABILITY Y BAS62698905 9/8/2024 918/2025 COMBINED tSINGLE LIMIT $1,000,000 <br /> Ea acciden <br /> Ix <br /> ANY AUTO BODILY INJURY(Per person) $ <br /> OWNED SCHEDULEDBODILY INJURY Per accidentAUTOS ONLY AUTOS ( ) $ <br /> HIRED X NON-OWNED PROPERTY DAMAGE $ <br /> AUTOS ONLY AUTOS ONLY Pe_r accident <br /> UMBRELLA LIAB OCCUR EACH OCCURRENCE $ <br /> EXCESS LIAR HCLAIMS-MADE AGGREGATE $ <br /> BED RETENTION$ $ <br /> C WORKERS COMPENSATION Y SWC1495275 619I2024 6/912025 X STATUTE OERH AND EMPLOYERS'LIABILITY Y f N <br /> ANYPROPRIETORIPARTNEWEXECUTIVE ❑ E.L.EACH ACCIDENT $1,000,000 <br /> OFFICERIMEMBEREXCLUDED? NIA <br /> (Mandatory in NHI E.L.DISEASE-EA EMPLOYEE $1,000,000 <br /> If yes,describe under <br /> DESCRIPTION OF OPERATIONS below I E.L.DISEASE-POLICY LIMIT $1,000,000 <br /> DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached if more space is required) <br /> RE:All CA Operations performed by the Named Insured. <br /> The City of Santa Ana,its officers,officials,employees and volunteers are included as Additional Insured,with Primary/Non-Contributory and Waiver of <br /> Subrogation, as respects to General Liability and Auto Liability,per Forms CG8810 0413,AC8543 0821 and CNA0401 0618.Waiver of Subrogation applies to <br /> Workers'Compensation per form WC0003 When required by Written Contact. 30 Day Notice of Cancellation.(10 Day Notice for Non-Payment) <br /> Tu Tran Digitally signed by <br /> Tu Tran Nguyen <br /> Nguyen °"".07004 APPROVED <br /> CERTIFICATE HOLDER CANCELLATION By Tu Tran Nguyen at 3:33 pm, Mar 24, 2025 <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> ACCORDANCE WITH THE POLICY PROVISIONS. <br /> City of Santa Ana Risk Management Division <br /> 20 Civic Center Plaza <br /> Santa Ana, CA 92702 AUTHORIZED REPRESENTATIVE <br /> c� ` <br /> O 1988-2015 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD <br /> THIS CERTIFICATE SUPERSEDES PREVIOUSLY ISSUED CERTIFICATE <br />