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C�® DATE(MmIDwrm) A C" CERTIFICATE OF LIABILITY INSURANCE 0512712025 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(ios) 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 Tob Moser N ME: y StateFarm Toby Moser (A/C,No Ezt: 303-494-4554 AXAIC N® 1295 South Broadway Suite A E-MAIL tab moser.le25 statefarm.com �,r, E35 Y• _ INSURERS AFFORDING COVERAGE NAIC 4 Boulder CO 803056769 INSURER A: State Farm Mutual Automobile Insurance Company 25178 INSURED INSURER B Martin,Lisa INSURERC: 12350 COUNTY ROAD 195 INSURER D INSURER E SALIDA CO B12019367 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. IN R ADD SUB ---POLICY 5FF P E LTR TYPE OF INSURANCE IN9D WVD POLICY NUMBER MMIDDIYYYY MMIDDIYYYY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S CLAIMS-MADE1-1 OCCUR DAMAGE TO RENTED SES Ea ocurrencel S MED EXP(Any one person) s PERSONAL&ADV INJURY s GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE s PRO POLICY JECT LOC PRODUCTS-COMP/OP AGG S OTHER: S AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 676 9616-F17-06A 12117/2024 06/17/2025 Ea acciden S ANY AUTO BODILY INJURY(Per person) s 1,000,000 A OWNED SCHEDULED Y Y AUTOS ONLY X AUTOS BODILY INJURY(Per accident) S 1,000,000 HIRED NON-OWNED AUTOS ONLY AUTOS ONLY Per acciden[ S 1,QQQ,QQO s UMBRELLA LIAB OCCUR EACH OCCURRENCE S EXCESS LIAR HCLAIMS-MARE AGGREGATE S DED RETENTION $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY $ ANY PROPRIETOPJPARTNERIEXECUTfVE YIN E.L,EACH ACCIDENT OFFICERIMEMBER EXCLUDED? ❑ N!A S (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE S If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) State Farm Insurance agrees to waive all rights of subrogation against City,its City Council,its officers,officials,employees,agents,and volunteers for lasses paid under the terms of any policy which arise from work performed by Consultant under this Agreement." APPROVED By To Tran Nguyen at 2:32 pm,Jun 19,2025 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. 20 Civic Center Plaza AUTHORIZED REPRESENTATIVE Santa Ana CA 92701 This farm was system-generated on 0512712025 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD 1001486 2005 155279 205 01-19-2023