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AC" " CERTIFICATE OF LIABILITY INSURANCE D 03/05/2025 4MMIDDNYYY) 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 poiicy(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 Gareth Nickerson NAME: PHONE 909 385 3200 FAX A!C No: Gareth Nickerson Agency LLC E-MAIL gnickerson@farmersagent,com ADDRESS: 27194 Baseline S(Unit C INSURER(M AFFORDING COVERAGE NAIC# Highland CA.92346 INSURERA: NORTHFIELD INSURANCE 27987 INSURED INSURER B: KINSALE 38920 IWATER INC INSURER C: MID CENTURY COMPANY 21687 12 GOODYEAR SUITE 130 INSURER D: TRUCK INSURANCE EXCHANGE 2 7709 IRVINE CA 92618-3747 INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER; THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HA 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. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LTR POLICYNUMBER 4MMIDDfYYYYI (MMIDDfYYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACHOCCURRENCF $ 1,000,000 �/ DAMAG TED 100,000 CLAIMS-MADE X OCCUR PREMISES Es occurrence $ MED EXP(Any one person) $ 5,000 A Y WH008318 10/27/2024 10127/2025 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE $ 2,000,000 X POLICY❑PRO- ❑LOC 2,000,000 JECT PRODUCTS $ OTHER' $ AUTOMOBILE LIABILITY COMBINED SINGLELIMIT $ (Fa accident) ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY Per accident $ AUTOS ONLY AUTOS } HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY per accident X UMBRELLALIAB X OCCUR EACH OCCURRENCE $ 5,000,000 EXCESS LIAR CLAIMS-MADE 0100212520-1 10/27/2024 1012712025, AGGREGATE $ 5,000,000 DED RETENTION$ $ WORKERS COMPENSATION X STATUTE ERH AND EMPLOYERS'LIABILITY Y I N ANYPROPRIETORIPARTNERIFXECUTIVE E.L.EACH ACCIDENT $1,000,000 C OFFICER/MEMBEREXCLUDED? NIA A09505451 02l15I2025 02115I202fi (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $1 000 000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) CERTIFICATE HOLDER ISADDITIONAL INSURED. CERTIFICATE OF INSURANCE SHALL PROVIDE(30)THIRTY DAYS WRITTEN NOTICE OF CANCELLATION CERTIFICATE HOLDER IS ADDITIONAL INSURED ON THE NAMED INSUREDS GENERAL LIABILITY POLICY.WAIVER OF SUBROGATION APPLIES IN FAVOR OF THE CERTIFICATE HOLDER ON WORKERS COMPENSATION POLICY Tu Tran °uaTlmsigned by APPROVED o,ce:zozs.o3.o Tu Tran Nguyen of 1.5U Nguyen ,s;s,ob-oa�aa' Ypm,Mar07,2023 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. RISK MANAGEMENT DIVISION 20 CIVIC CENTER PLAZA 4TH FLOOR AUTHORIZED REPRESENTATIVE SANTAANA CA 92701 ©1988.2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD