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CERTIFICATE OF LIABILITY INSURANCE D 05/21/2025 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 INSURER, the policy(ies) must be endorsed. If SUBROGATIONIS 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 HUB INTL MOUNTAIN STATES LTDIPHS 41451261 PHONE (866)467-8730 FAX (AIC,No,Ext): (AIC,No): The Hartford Business Service Center 3601)Wiseman Blvd E-MAIL San Antonio,TX 75251 ADDRESS: INSURERIS)AFFORDING COVERAGE NAIC# INSURED INSURERA: Hartford Underwriters Insurance Company 30104 MARTHA VAN ROOIJEN DBA MVR CONSULTING INSURER B: PO BOX 236 CALIMESA CA 92320-0236 INSURERC: INSURER D: INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS 1S 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. INSR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSR WVD ❑ ❑ COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $1,000,000 _ CLAIMS-MADE�OCCUR DAMAGE TO RENTED $1,000,000 PREMISES Ea occurrence X General Liability MED EXP(Any one pwson) $10,000 A X X 41 SBU BSiAC2 05/19/2025 05/19/2020 PERSONAL&ADV INJURY $1,000,000 GFN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 X POLICY❑PRO ❑LOC PRODUCTS-COMP/OP AGO $2,000,000 JECT OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $1,000,00a Ea accident ANY AUTO BODILY INJURY(Per perscn) A ALL OWNED SCHEDULED 41 SBU BS1AC2 05/19/2025 05/19/2026 BODILY INJURY(Per acedent) AUTOS AUTOS HIRED NON-OWNED PROPERTY DAMAGE X AUTOS r AUTOS (Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE EXCESS LIAB CLAIMS- MADE AGGREGATE DED RETENTION$ WORKERS COMPENSATION PER OTH- AN❑EMPLOYERS'LIABILITY STATUTE I ER ANY YIN E.L.EACH AM[DENT PROPRIETO W PARTNERIEXECUTIVE NIA OFFICERIMEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE (Mandatory in NH) . If yes,describe under 67 lyl9Py4) y1 - E.L,DISEASE-POLICY LIMIT DESCRIPTION OF OPERATIONS below [APPROVED D By Tv Tram Nguyen at 108 pm,MarP9,2026 L00DESCRIPTIOId OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schodule,may be attached if more space is required) osesual to the Insured's Operations.Waiver of Subrogation applies in favor of the Certificate Holder per the Business Liability Coverage Form SL 00,attached to this policy.The Business I-lability Coverage Part includes a Blanket Additional Insured By Contract Endorsement,Form SL 30 32. CERTIFICATE HOLDER CANCELLATION CITY OF SANTA ANA SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED ATTENTION:ZED KEKLILA BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED 20 CIVIC CENTER PLZ#M-43 IN ACCORDANCE WITH THE POLICY PROVISIONS. SANTA ANA CA 92701-405B AUTHORfZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION,All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD