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® DATE(MMIODIYYYY) A`�a CERTIFICATE OF LIABILITY INSURANCE 09/23/2024 THIS CERTIFICATE IS 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 have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS 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: Hiscox Inc.dlblal Hiscox Insurance Agency in CA PHONE - FAX C Na Ext: (888)2023007 AIC No): _ 5 Concourse Parkway EMAIL ss: contact@hiscox.com Suite 2150 Atlanta GA,30328 INSURERS AFFORDING COVERAGE NAIC# INSURER A: Hiscox Insurance Company Inc 10200 INSURED INSURER B Nastich Law,a Professional Corporation INSURER C 2341 Derby Street Berkeley,CA 94705 INSURER D: 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 ADDL SUER POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE IN p POLICY NUMBER MMPDD/YYYY MMIDDIYYYY X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR PREMISES IEa occurrence) $ 0 X_ CGL is an BOP Form MED EXP(Any one person) $ 10,000 A Y P103.767.918.1 09/07/2024 09/07/2025 PERSONAL&AOV INJURY $ 0 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY❑ PROJECT LOC PRODUCTS-COMPIOP AGG $ 2.000,000 $ OTHER: A COMBINED SINGLE LIMIT AUTOMOBILE LIABILITYaccident) $ Ea accldenl ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED P103.767.918.1 09/07/2024 09/07/2025 BODILY INJURY(Per accident) $ AUTOS (AUTOS PROPERTY DAMAGE A X X NON-OWNED Per accident $ HIRED AUTOS AUTOS GIST HNOA LirT $ 1,000.000 (per occurrence UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER YIN ANYPROPRIETORIPARTNERIEXECUTIVE ❑ EL EACH ACCIDENT $ OFF ICERIMEMBER EXCLUDED? N!A (Mandatory in NH) E-L-DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L-DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) RF:Administrative Hearing Officers(24-052) CERTIFICATE HOLDER CANCELLATION City of Santa Ana Center hA-17 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 20 Civic Centor Plaza Santa Ana, THE EXPIRATION DATE THEREOF NOTICE WILL BE DELIVERED IN 9 lazy ACCORDANCE WITH THE POLICY PRC o..a R .�at^ AMr uVma,tl7Mdon AUTHORIZED REPRESENTATIVE Y REVIEwED&APPRoVID BY: F3,Er �- A AE�ucdo y rid Risk Management Specialist O 1988-2015 ACORD ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD