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AC"R" CERTIFICATE OF LIABILITY INSURANCE FDATE(MMIDDlYYYY) �.� 04/25/2025 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: BIII SIIVBStfi Apgar&Bullard Insurance Services IAC.PHONENo, . (714)985-9630 AIc No): (714)985-9754 265D E.Imperial H Suite 205 E-MAIL PandCadmin a arbullard.com P Hwy ADDRESS: P9 INSUREI AFFORDING COVERAGE NAIL N Brea CA 92821 INSURERA: PHILADELPHIA INSURANCE CO 524210 INSURED INSURER B: Orange County Crazies INSURER C: 809 North Main Street INSURER D: INSURER E: Santa Ana CA 92701 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. INSIR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE II WVQ SUBR POLICY NUMBER IMIDDIYYYY MMIDDIYYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE �X OCCUR DAMAGE TO RENTED PREMISES Ea occurrence $ 100,000 MED EXP(Any one person) S 5,000 A x x PHPK2581220-011 08/14/2024 08/14/2025 PERSONAL&ADV INJURY S 1,000,000 GI AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE S 2,000,000 X POLICY❑ PE LOG PRODUCTS-COMPlOP AGG $ 2.000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) S OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident UMBRELLA LIAB HOCCUR EACH OCCURRENCE S EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION S S WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY YIN STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? ❑ N I A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE S If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) RE:Location:809 N. Main address-De Pietro Performance center. Who is an insured is amended to include City of Santa Ana,its officers,employees,agents and representatives as additional insured per policy endorsements when required by written contract. Tu Tran Digitally signed by APPROVED Tu Tran Nguyen Date:2025.04.30 Nguyen 07:58:13 07'00' By Tu Tran Nguyen at 7:57 am,Apr 30,2025 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Santa Ana ACCORDANCE WITH THE POLICY PROVISIONS. Attention:Executive Director,Community Development Agency AUTHORIZED REPRESENTATIVE 20 Civic Center Plaza M-25 Santa Ana,CA 92702 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD