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John Butler <br /> S()L 111111 N ( M II(OILS Director, Corporate Risk Management <br /> E DISON P.O. Box n800 <br /> ut 2Z44'UU'alnut Grove Avenue <br /> Rosemead, CA 91770 <br /> An 1.01SO 1%'If.R% IT10%ri <br /> CERTIFICATE OF SELF INSURANCE <br /> Issued To: <br /> Certificate Holder: City of Santa Ana, a charter city and municipal corporation, Clerk of the City <br /> Council <br /> Address: 20 Civic Center Plaza (M-30), P.O. Box 1988 <br /> City: Santa Ana <br /> State: CA <br /> Zip Code 92702-1988 <br /> The self-insurance programs listed below are in force with regard to the following: <br /> Loc:Delhi Park (33.715842, -117.861320) Term:May 31, 2023-June 30, 2025 <br /> Use:Installation of stub pole and anchor <br /> Type of Self-Insurance Policy Policy Period Limits of Liability <br /> Program No. <br /> Commercial Self- Continuous $1 Million per Occurrence & <br /> General Liability Insured $2 Million Aggregate <br /> (Includes Auto Liability) for Bodily Injury& Property Damage <br /> Workers' Compensation Self- Continuous Statutory (WC) <br /> & Employer's Liability Insured $1 Million (EL)Aggregate <br /> This certificate is not valid unless signed by an authorized representative of Southern California <br /> Edison's Risk Management Department. Additional Certificate Holder Status:The Certificate Holder is <br /> (a) additional insured under the general liability program[s] noted above; (b) the general liability <br /> program[s] noted above are primary, and any insurance or self-insurance maintained by certificate <br /> holder is excess and non-contributory; (c) waiver of subrogation applies to the general liability and <br /> workers' compensation] programs note above; (d) 30-days` notice of cancellation will be provided by <br /> Edison. <br /> i �GL�PJL <br /> Insurance Risk Management <br />