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ACC CERTIFICATE OF LIABILITY INSURANCE DATE(MMfDD1YYYY) 06/0612025 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 CIAi NAME: Collectors Insurance Agency,Inc. PHONE Ext: {952)926-6547 'FAX No: (952)928-3837 3200 Courthouse Lane ADDRESS: eollectorsinsurance@acainternational.org INSURERS)AFFORDING COVERAGE NAIC# Eagan MN 55121 INSURERA: Nationwide Assurance Company 10723 INSURED INSURER B: Nationwide Mutual Insurance Company 23787 Be Services,Inc. INSURER C: 550 DISC Dr INSURER D: INSURER E Longmont CO 80503-9343 INSURERF: COVERAGES CERTIFICATE NUMBER: 10013709 REVISION NUMBER: THIS IS TO CERTIFYTHATTHE PCLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMEDABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE 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 AUDL sUHR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MM1DDlYYYY MMIDDIYYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 'DAMArE TO RENTED CLAIMS-MARE �OCCUR PREMISES Ea occurrence) $ 300,000 MED EXP(Any one person} $ 5.000 A Y ACPBPO13140083377 03/2312025 03/23/2026 PERSONAL&ADVINJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIESPER: GENERAL AGGREGATE $ 2,000,000 POLICY LF7 JPECT 7 LOC PRODUCTS-COMP/OP AGO $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident) $ INCLUDED INGL ANY AUTO BODILY l NJ URY(Per person) $ A OWNED SCHEDULED ACPBP013140083377 03/23/2025 03/23/2026 BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS v HIRED v NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY /� AUTOS ONLY Per accident 5 x UMBRELLA LIAB M OCCUR EACH OCCURRENCE $ 5,000,000 B EXCESS LIAB CLAIMS MADE ACPCU013140083377 03/23/2025 0312312026 AGGREGATE $ 5,000,000 DED I I RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY YIN STATUTE ER ANY PROPRIETORIPARTNERfEXECUTIVE OFFICERIM£MBER EXCLUDED? NIA E.L.EACH ACCIDENT $ (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes.describe under DESCRIPTION OF OPERATIONS be€ow E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES ACORD 101,Additional Remarks Schedule,may be attached if more space is required) TLI Tra Il Digitally sign d Tu Tian Ngu n IT IS AGREED THAT CITY OF SANTAANA IS INCLUDED AS ADDITIONAL INSURED SOLELY AS THEIR INTERESTS MAY APPEAR IN ACCORDANCE ❑ate:2025.0_, WITH THE PROVISIONS OF THE POLICY FORM. Nguyen aBas:3o-or❑ APPROVED By 7u?'ran Nguyen at 8:15 am,Jul 11,2v25 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN CITY OF SANTAANA ACCORDANCE WITH THE POLICY PROVISIONS. PO BOX 1988 AUTHORIZED REPRESENTATIVE SANTAANA CA 92702 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD