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® DATE(MMIDDIYYYY) CERTIFICATE OF LIABILITY INSURANCE 8127/2025 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(tes)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). CONTACT Kat Kalata PRODUCER NAME; Higginbotham Insurance Agency, Inc. PHONE 800 728-2374 FAX No),817-882-9284 500 W. 13th Street E-MAIL Fort Worth TX 76102 ADDRESS: kalatak@yahoo.com INSURER IS)AFFORDING COVERAGE NAIC# LICenSe#:2081754 INSURERA:Service Lloyds Insurance Co. 43389 INSURED 02XHUMA-01 INSURER B:Twin City Fire Insurance Company 29459 02X Human Performance INSURERC; DBA CGLM, LLC 1 Mill Whart Plaza, Unit S12 INSURER D: Scituate MA 02066 INSURER E; INSURER F: COVERAGES CERTIFICATE NUMBER:1353234820 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. ADDL SUBR POLICY EFF POLICY EXP ILTR TYPE OF INSURANCE POLICY NUMBER M DDlYY MMfDDlY YY LIMITS COMMERCIALGENERALLIABILITY FACHOCCURRENCE $ DAh9TE TO RENTED CLAIMS-MADE OCCUR PREMISES Ea occurrence $ MFD EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY PRO LOG PRODUCTS-COMPIOPAGG $ JECT OTHER: AUTOMOBILE LIABILITY ertSINGLE LIMIT $ COMBINED aac d ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS PROPERTY DAMAGE HIRED NON-OWNED per accident $ AUTOS ONLY AUTOS ONLY UMBRELLALIAB HOCCUR EACHOCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ OE13TI RETENTION _ $ A WORKERS COMPENSATION SLICWC110650601 4/1/2025 4/1/2026 X STATUTE ERH AND EMPLOYERS'LIABILITY Y I N ANYPROPRIETOFUPARTNERIEXECUTIVE N NIA E.L.EACH ACCIDENT $1,000,000 OFFICERIMEMBEREXCLUE E.L.UISEASE-EA EMPLOYEE $1,000,000 tMandatory In NH) If yes,describe under E.L.DISEASE-POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS below 8 Employrrert Practices LInblllly 46KB073795625 4/1/2025 4/112026 LIMIt of Liability 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) The Workers'Compensation policy Includes a blanket automatic waiver of subrogation endorsement that provides this feature only when there is a written contract between the named Insured and the certificate holder that requires such provision.30 Day Notice of Cancellation provided. City of Santa Ana,Its City Council,officers,officials,employees,agents,and volunteers are provided with a blanket automatic waiver of subrogation. APPROVED ey Tu Tran Nguyen at 2:32 prn,.Aug 27,2624 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL HE DELIVERED IN City of Santa Ana ACCORDANCE WITH THE POLICY PROVISIONS. Attention:Santa Ana Police Department 60 Civic Center Plaza(M-18) AUTHORIZEtlR RESENTATIVE Santa Ana CA 92701 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD