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<br /> ACORN® CERTIFICATE OF LIABILITY INSURANCE
<br /> 7i1i20262/2025
<br /> THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
<br /> CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
<br /> BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
<br /> REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
<br /> IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed.
<br /> If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on
<br /> this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
<br /> PRODUCER Lockton Companies,LLC CONTACT
<br /> NAME:
<br /> DBA Lockton Insurance Brokers,LLC in CA PHONE FAX
<br /> CA license#OF15767 A/C Ext: A/C No
<br /> E-MAIL
<br /> 444 W.47th St.,Ste.900 ADDRESS:
<br /> Kansas City MO 64112-1906 INSURER(S)AFFORDING COVERAGE NAIC#
<br /> (816)960-9000 kcasu@lockton.com INSURER A:Arch Insurance Company 11150
<br /> INSURED VOLKSWAGEN GROUP OF AMERICA,INC. INSURER B:Arch Indemnity Insurance Company 30830
<br /> 1309217 1950 OPPORTUNITY WAY,SUITE 1500 INSURER C:American Guarantee and Liab.Ins. Co. 26247
<br /> RESTON VA 20190 INSURER D:
<br /> INSURER E:
<br /> INSURER F:
<br /> COVERAGES CERTIFICATE NUMBER: 22352622 REVISION NUMBER: XXXxxxx
<br /> THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
<br /> INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
<br /> CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
<br /> EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br /> INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS
<br /> LTR INSD WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY
<br /> A X COMMERCIAL GENERAL LIABILITY Y N 41GPPI092101 7/1/2025 7/1/2026 EACH OCCURRENCE $ 1,000,000
<br /> DAMAGE TO RENTED
<br /> CLAIMS-MADE 1XI OCCUR PREMISES
<br /> (E.occurrence)
<br /> ccurrrence) $ 300,000
<br /> MED EXP(Any one person) $ 5,000
<br /> PERSONAL&ADV INJURY $ 1,000,000
<br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000
<br /> X POLICY n PRO LOC PRODUCTS-COMP/OP AGG $ 1,000,000
<br /> JECT
<br /> OTHER: $
<br /> A AUTOMOBILE LIABILITY Y N 41CABI092101 AOS 7/1/2025 7/1/2026 COMBINED SINGLE LIMIT $
<br /> ( ) Ea accident 2,000,000
<br /> A X ANY AUTO 41 CAB 1092201.(MA) 7/1/2025 7/1/2026 BODILY INJURY(Per person) $
<br /> OWNED SCHEDULED BODILY INJURY(Per accident) $
<br /> AUTOS ONLY AUTOS XXX�G �
<br /> HIRED NON-OWNED PROPERTY DAMAGE $ XXX� �
<br /> AUTOS ONLY AUTOS ONLY Per accident
<br /> $ xxxxxxx
<br /> C X UMBRELLA LIAB X OCCUR N N AUC 4569365-04 7/1/2025 7/1/2026 EACH OCCURRENCE $ 5,000,000
<br /> EXCESS LIAB CLAIMS-MADE AGGREGATE $ 5,000,000
<br /> DED I I RETENTION$ $ XXXXG x
<br /> WORKERS COMPENSATION N X STATUTE EO
<br /> B RH
<br /> AND EMPLOYERS'LIABILITY
<br /> ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N N/A 44WCI1092201 7/1/2025 7/1/2026 E.L.EACH ACCIDENT $ 1,000,000
<br /> OFFICER/MEMBER EXCLUDED?
<br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000
<br /> If yes,describe under
<br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000
<br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
<br /> CITY OF SANTA ANA,ITS CITY COUNCIL,ITS OFFICERS,OFFICIALS,EMPLOYEES,AGENTS,AND VOLUNTEERS ARE ADDITIONAL INSURED ON
<br /> GENERAL LIABILITY AND AUTO LIABILITY,IF REQUIRED BY WRITTEN CONTRACT AND SUBJECT TO THE TERMS AND CONDITIONS OF THE POLICY.
<br /> Digitally signed
<br /> Tu Tran by Tu APPROVED
<br /> Nguyenn
<br /> Ng Uy211 10:1521-07'00' By Tu Tran Nguyen at 10:13 am,Sep 10,2025
<br /> 10:1521-0T00'
<br /> for Luisa Najera
<br /> CERTIFICATE HOLDER CANCELLATION
<br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> 622 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br /> 22352
<br /> CITY 62 SANTA ANA ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> M-XX
<br /> SANTA ANA CA 92701 AUTHORIZED REPRESENTATIV r
<br /> r/
<br /> @ 1988 015 ACORD CORPORATION. All rights reserved.
<br /> ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD
<br />
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