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HomeMy WebLinkAboutWESTERN A/V & SECURITY (2)INSURANCE ON FILE WORK MAY PROCIFED MAYOR�i UN11t I iSUi 4,IdCIL EXPIK Valerie Amezcua y m� CITY CLERK MAYOR PRO TEM Benjamin Vazquez DATE: OCT 7 7 2025 COUNCILMEMBERS Phil Bacerra Johnathan Ryan Hernandez Jessie Lopez David Penaloza That vlet Phan CITY OF SANTA ANA o • p VvA ( 2) PUBLIC WORKS AGENCY Foillio n V-r0111kwr, (DZ) 20 Civic Center Plaza r P.O. Box 1988 Santa Ana, California 92702 www.santa-ana.org June 16, 2025 Western AN & Security 1592 North Batavia Street, Suite 2 Orange, CA 92867 Attn: Hailey Schellin A-2022-107-01 Re: Extension of Agreement to Provide Workstation and Video Monitoring Upgrades (A-2022-107) CITY MANAGER Alvaro Nunez CITY ATTORNEY Sonia R. Carvalho CITY CLERK Jennifer L. Hall Pursuant to Section 3 ("Term") of the above -referenced Agreement, entered into by Western AN & Security, and the City of Santa Ana, dated June 21, 2022 the time period of the Agreement is hereby extended for an additional two-year period, from June 21, 2025 through June 20, 2027. Any insurance certificates are required to be extended and/or renewed to cover this extension. All other terms and conditions of the Agreement remain unchanged and in full force and effect. Sincerely, aba, Executive Director, Public Works Agency CITY OF :7f A varo Nunez City Manager APPROVED AS TO FORM Kyfe Nellesen Assistant City Attorney ATTEST City Clerk WESTERN AN & SECURITY By: Kevin Mahkorn Title: Service Director SANTA ANA CITY COUNCIL Valerie Amezcua Benjamin Vazquez Thai Viet Phan Jessia Lopez Phil Bacerm Johnathan Ryan Hernandez David Penaloza Mayor Mayor Pro Tem - Ward 2 Ward 1 Ward 3 ward 4 Ward 5 Ward 6 vamezcuarov7sanfa-ana_org bvaz uez Santa-ana.or tphanfo —ta-ana am iessielooezesonla-ana.org pbacertari$santa-ana om Irvanhemandezasant—na om rl enalozaasama-ana orp ACC?R6r CERTIFICATE OF LIABILITY INSURANCE `.� DATE(MMIDDlYYYY) 0710912025 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 $tateFaarm Javier Misiego j 227 20th St Suite 104 Al Al NAMEACT Melanie Duarte PHONE 714-772-3838 FAX A1C No : 714-808 6431 E-MAIL s: Melanie.a.duarte.vadk7j@statefarm.com INSURER(S) AFFORDING COVERAGE NAIC # Newport Beach CA 92663 INSURER A : State Farm Mutual Automobile Insurance Company 25178 INSURED INSURER B : State Farm Fire and Casualty Company 25143 WESTERN AIV INC INSURER c: State Farm General Insurance Company 25151 1592 N BATAVIA ST STE 2 INSURER D: ORANGE, CA 92867 INSURERE: INSURER F t COVERAGES CERTIFICATE NUMBER: 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. ILTR TYPE OF INSURANCE ADDLSUBR INSM WVn POLICY NUMBER MMIDDIYYYY POLICY EFF MMIDDY� LIMITS X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR EACH OCCURRENCE 5 2,000,000 CAMA(3 TO RENTED PREMISES Ea occurrence) 500.000 MED EXP (Any one person) 3 5,000 PERSONAL s ADV INJURY s 1,C00,000 C Y Y 92-GY-D812-0 10/31/2024 10/3112025 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY JECT LOG GENERAL AGGREGATE s 4,fl00,000 PRODUCTS-COMPfCPAGG S 4,000,000 S 248,400 OTHER. AUTOMOBILE LIABILITY ANY AUTO Y Y 661 2954-E13-75 05/1312026 11/13/2025 COMBINED eISINGLE LIMIT s 1,000,000 BODILY INJURY {Per person) S I OWNEDIxSCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) S HIRED NON -OWNED AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE Peraceldenl $ S X UMBRELLA LIAR M OCCUR EACH OCCURRENCE S 5,000,000 C EXCESS LIAR CLAIMS -MADE N/A N/A 92-XC-0351-6 12/14/2023 12114/2025 AGGREGATE S QED RETENTIONS S 1 B. WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y I NFIR OFFICERIMEMBEERANY /EXCLUDED7ECUTfVE ❑ NIA Y 92-MW-H114-6 01101/2025 01/01/2026 X STATUTE OTH E.LEACHACCIDENT S 1,o9fl,l?Ofl E.L.DISEASE - EA EMPLOYE S 1,000,000 (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT S 1,000,000 SURETY BOND B 92-KN-M222-7 06/16/2025 06/1612027 $25,000 DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES (ACORD 101, Additional Remarks Schedule, may he attached if more space is required) ofgl[aI sinned AUDIO VISUAL SYSTEMS INTEGRATION Tu Tran byrk Trzn Nguyen Business Location 1592 N Batavia St., Ste 2, Orange, CA 92867 Nguyen nate.2025.10.03 1634:58 -07'00' It is agreed that is is the intention of the Company to provide 30 days written notice prior to the cancellation of the policy designated in this certificate. However, the Company assumes no liability for failure to do so, �APPROVED By Tu Tran Nguyen at 4:34 pm, Oct 03, 2025 CERTIFICATE HOLDER City of Santa Ana Water Resources M85 220 S Daisy Ave Bldg A Santa Ana, CA 92703 CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE @ 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD 199148 132849.13 04-22-2020 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 (Ed. 4-84) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - CALIFORNIA We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. The additional premium for this endorsement shall be otherwise due on such remuneration. Person or Organization City of Santa Ana, its City Council, Officers, Officials, Employees, Agents, and Volunteers Water Resources ME 220 S Daisy Ave Bldg A Santa Ana, CA 92703 5 % of the California workers' compensation premium Schedule Job Description Audio Visual Systems Integration This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below Is required only when this endorsement Is Issued subsequent to preparation of the policy.) Endorsement Effective 07/28/25 Insured WESTERN A/V 1592 N BATAVIA ST STE 2 ORANGE CA 92867-3554 Policy No. 92 MWH114 6 Endorsement No, Insurance Company State Farm Fire and Casualty Company Countersigned By WC 04 03 06 (Ed. 4-84) 1007722 124282.2 01-25-2019 ZZ Policy No. 92-GY-D812-0 75-61 F8 CMP-4786.1 Page 1 of 2 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CMP4786,1 ADDITIONAL INSURED -- OWNERS, LESSEES, OR CONTRACTORS (Scheduled) This endorsement modifies insurance provided under the following: BUSINESSOWNERS COVERAGE FORM SCHEDULE Policy Number: 92-GY-D812-0 Named Insured: WESTERN A/V INC 1592 N BATAVIA ST STE 2 ORANGE CA 92867-3554 Name And Address Of Additional Insured Person Or Organization: City of Santa Ana , its City Council, officers, officials, employees, agents, and volunteers Water Resources M85 220 S Daisy Ave Bldg A SANTA ANA CA 92703 1. SECTION II — WHO IS AN INSURED of b. If coverage provided to the additional in - SECTION II — LIABILITY is amended to in- sured is required by a contract or agree- clude, as an additional insured, any person or ment, the insurance provided to the organization shown in the Schedule, but only "bodily additional insured will not be broader than with respect to liability for injury", "property damage", or "personal and advertis- that which you are required by the contract ing injury" caused, in whole or in part, by: or agreement to provide for such addition- a. Ongoing Operations al insured; and (1) Your acts or omissions; or c. If the contract or agreement between you and the additional insured is governed by (2) The acts or omissions of those acting California Civil Code Section 2782 or on your behalf; 2782.05, the insurance provided to the in the performance of your ongoing opera- additional insured is the lesser of that which: tions for that additional insured; or b. Products - Completed Operations (1) Is allowed for the satisfaction of a de- fense or indemnity obligation by Cali - "Your work" performed for that additional fornia Civil Code Section 2782 or insured and included in the "products- 2782.05 for your sole liability; or completed operations hazard". (2) You are required by contract or However, Paragraph 1. above is subject to the agreement to provide for such addi- following: tional insured. a. The insurance afforded to the additional We have no duty to defend or indemnify the insured only applies to the extent permit- additional insured under this endorsement an- ted by law; til a claim or "suit" is tendered to us. ©, Copyright, State Farm Mutual Automobile Insurance Company, 2013 Includes copyrighted material of Insurance Services Office, Inc., with its permission. CONTINUED 2. Any insurance provided to the additional in- sured shall only apply with respect to a claim made or a "suit" brought for damages for which you are provided coverage. 3. With respect to the insurance afforded to the additional insured, the following is added to SECTION II -- LIMITS OF INSURANCE: If coverage provided to the additional insured is required by contract or agreement, the most we will pay on behalf of the additional insured will be the lesser of the amount of insurance: a. Required by the contract or agreement; or b. Available under the applicable Limits Of Insurance shown in the Declarations. This endorsement shall not increase the ap- plicable Limits Of Insurance shown in the Declarations, 4. With respect to the insurance afforded to the additional insured, the following is added to Paragraph 3. Duties In The Event Of Occur- rence, Offense, Claim Or Suit of SECTION 11-- GENERAL CONDITIONS: The additional insured must: a. See to it that we are notified as soon as practicable of an `occurrence" or an of- fense which may result in a claim. To the extent possible, notice should include: (1) How, when and where the "occur- rence" or offense took place; (2) The names and addresses of any in- jured persons and witnesses; and CMP-4786.1 Page 2 of 2 (3) The nature and location of any injury or damage arising out of the "occur- rence" or offense; b. Tender the defense and indemnity of any claim or "suit" to us and to all other insur- ers who may have insurance potentially available to the additional insured; and c. Agree to make available any other insur- ance the additional insured has for de- fense or damages for which we would provide coverage under SECTION II — LIABILITY. 5. With respect to the insurance afforded the ad- ditional insured, the following replaces SEC- TION II —LIABILITY of Paragraph 7. Other Insurance of SECTION I AND SECTION II — COMMON POLICY CONDITIONS: a. This insurance is primary to and will not seek contribution from any other insurance available to the additional insured, provided that the additional insured is a named in- sured under such other insurance. b. Regardless of any agreement between you and the additional insured, this insur- ance is excess over any other insurance whether primary, excess, contingent or on any other basis for which the additional in- sured has been added as an additional in- sured on other policies. There will be no refund of premium in the event this endorsement is cancelled. All other policy provisions apply. CMP-4788.1 ©, Copyright, State Farm Mutual Automobile Insurance Company, 2013 Includes copyrighted material of Insurance Services Office, inc., with its permission, ZZ Policy No. 92-GY-D812-0 75-61 F8 CMP-4787 Page 1 of 1 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CMP-4787 WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: BUSINESSOWNERS COVERAGE FORM SCHEDULE Policy Number: 92-GY-D812-0 Named Insured: WESTERN A/V INC 1592 N BATAVIA ST STE 2 ORANGE CA 92867-3554 Name And Address Of Person Or Organization: City of Santa Ana , its City Council, officers, officials, employees, agents, and volunteers Water Resources M85 220 S Daisy Ave Bldg A SANTA ANA CA 92703 The following is added to Paragraph 10.b. of SECTION I AND SECTION II — COMMON POLICY CONDITIONS: We waive any right of recovery we may have against the person or organization shown in the Schedule because of payments we make for injury or damage arising out of: a. Your ongoing operations; or b. "Your work" done under contract with that person or organization and included in the "products - completed operations hazard". This waiver applies only to the person or organization shown in the Schedule. All other policy provisions apply. CMP-4787 ©, Copyright, State Farm Mutua[ Automobile Insurance Company, 2008 Includes copyrighted material of Insurance Services Office, Inc., with its permission. SfateFarm State Farm Mutual Automobile Insurance Company AO Box 2368 Bloomington !L 61702-2368 NAMED INSURED AT2 75-61 F8-4 A r 016114 6058 WESTERN A/V INC 1592 N BATAVIA ST STE 2 ORANGE CA 92867-3554 93234-4-A MUTL VOL L DECLARATIONS PAGE PAGE 1 OF 2 POLICY NUMBER 661 2954-El3-75U POLICY PERIOD JUL 28 2025 to NOV 13 2025 12:01 A.M. Standard Time STATE FARM PAYMENT PLAN NUMBER 1031434923 AGENT JAVIER MISIEGO 227 20TH ST STE 103 NEWPORT BEACH, CA 92663-4343 PHONE. V14)772-3838 DO NOT PAY PREMIUMS SHOWN ON THIS PAGE. IF AN AMOUNT IS DUE, THEN A SEPARATE STATEMENT IS ENCLOSED. YOUR CAR YEAR MAKE MODEL BODY STYLE VEHICLE ID. NUMBER CLASS 2024 FORD RANGER PICKUP 1 FTER4131-18RLE20753 000HCX10 SYMBOLS COVERAGE & LIMITS PREMIUMS Liability Coverage . $4i1.5S Bodily Injury Limits mxm�- Each Person, Each Aecident-<5 $1,000,000 $1,000,000 -_ � f=sProperty Damage Limit u. Each Accident $1,000,000 D Comprehensive Coverage-$2,000 Deductible $18.49 - G ,.. Collision Coverage - $2,000 Deductible_ �, H Emergency Road Service Coverage $2,99 Car Rental and Travel Expenses Coverage Limit - Car Rental Expense Each Day, Each Loss- $25 $600 .`...Uninsured Motor Vehicle CoveragQ Bodily Injury Limits Each Person, Each Accident $30,000 $50,000 U1 Uninsured Motor Vehicle Property Damage Coverage $$ 43 " Total premium for JUL 28 2025 to NOV 13 2025. $716.16 This is not a Nlf. IMPORTANT MESSAGES IMPORTANT NOTICE For your protection California law requires the following to appear with this policy: Any person who knowingly presents false or fraudulent information to obtain or amend insurance coverage or to make a claim for the payment of a loss is guilty of a crime and may be subject to fines and confinement in state prison. Replaced policy number 6612954-75T, Notice of insurance information collection practices - personal, family, or household insurance transactions: We may collect customer information from persons other than the Individual or individuals applying for coverage. Such customer information as well as other personal or privileged Information subsequently collected may, in certain circumstances, be disclosed to third parties without your authorization as permitted by law, You have the right to submit a written request to access, correct, amend, or delete your personal information and the right to receive a response within 30 days of submitting your request. If we deny your request, you have the right to file a statement with us containing the information you feel is accurate and fair along with the reasons you disagree with our denial. Instructions on how to file such request and our full privacy notice can be found www,statefarm.com/customer-caretprivacy-security/privacy or contact your State Farm Agent. Your total renewal premium for MAY 13 2025 to NOV 13 2025 is $1,228.40. Location used to determine rate charged-6353 CORTE DEL ABETO STE 106, CARLSBAD CA 92011-1437. CONTINUED 21350/16091 See Reverse Side 155-3866 CA.2 05.2002 �ota0251c} 11 MON (u1 a0251e) This policy is issued by State Farm Mutual Automobile Insurance Company. MUTUAL CONDITIONS 1. Membership. While this policy Is in force, the first Insured shown on the Declarations Page is entitled to vote at all meetings of members and to receive dividends the Board of Directors in Its discretion may declare in accordance with reasonable classifications and groupings of policyholders established by such Board. 2. No Contingent Liability. This policy is non -assessable. 3. Annual Meeting. The annual meeting of the members of the company shall be held at its home office at Bloomington, Illinois, on the second Monday of June at the hour of 10:00 A.M., unless the Board of Directors shall elect to change the time and place of such meeting, in which case, but not otherwise, due notice shall be mailed each member at the address disclosed In this policy at least 10 days prior thereto. In Witness Whereof, the State Farm Mutual Automobile Insurance Company has caused this policy to be signed by Its President and Secretary at Bloomington, Illinois. *-rn Secretary Presldent Important ... California law requires us to provide you with information for filing complaints with the State Insurance Department regarding the coverage and service provided under this policy. Complaints should be filed only after you and Stag Farm or your agent or other company representative have failed to reach a satisfactory agreement on a problem. Please forward such complaints to: California Department of Insurance Consumer Services Division 300 South Spring Street Los Angeles, CA 90013 Or file a complaint through the Department of Insurance's Internet Web site (www.insurance.ca.gov) Or call toll free 1-800-927-HELP (4357) NOTICE We are required to furnish you with the following information; 1. An automobile liability Insurance company may cancel a policy before the end of the current policy period for reasons described in the provision titled Cancellation which is located in the General Terms section of your policy (refer to the Contents in the beginning of your policy for the page number). 2. An automobile liability insurance company may increase the premium or refuse to renew the policy for any of the following roasons: a. Accident involvement by an insured, and whether an insured is at fault in the accident. b, A change in, or an addition of, an insured vehicle. c. A change in, or addition of, an insured under the policy. d. A change in the location of garaging of an insured vehicle. e. A change in the use of the insured vehicle. I. Convictions for violating any provision of the Vehicle Code or the Penal Code relating to the operation of a motor vehicle. g. The payment made by an insurer due to a claim filed by an insured or a third party. An automobile liability insurance company may increase the premium or refuse to renew the policy for reasons that are not listed above but which are lawful and not unfairly discriminatory. —b2 E10 StateFarm State Farm Mutual Automobile Insurance Company PO Box 2368 Bloomington !L 61702-2368 NAMED INSURED 75-61F-8-4 A A 016174 uu58 WESTERN A/V INC 1592 N BATAVIA ST STE 2 ORANGE CA 92867-3554 93234-4-A MUTL VOL DECLARATIONS PAGE PAGE 2 OF 2 POLICY NUMBER 661 2954-E13-75U POLICY PERIOD JUL 28 2025 to NOV 13 2025 12:01 A.M. Standard Time STATE FARM PAYMENT PLAN NUMBER 1031434923 EXCEPTIONS, POLICY BOOKLET & ENDORSEMENTS (See policy booklet & individual endorsements for coverage details.) YOUR POLICY CONSISTS OF THIS DECLARATIONS PAGE THE POLICY BOOKLET - FORM 9805ANY S�JBAND ANY ENDORSEMENTS NDORSRENEWAEMN TICTHAT APPLY, IACLUOING THOSE ISSUED TO YOU WITHCREDITOR- FORD MOTOR CREDIT - LIEN INSURANCE SERVICE CENTER, PO BOX 390858, MINNEAPOLIS MN 55439-0858. 01 6028BU ADDITIONAL INSURED-BRE CERRITOS OFFICE OWNER LLC, 3100 BRISTOL ST STE 200 COSTA MESA CA 92626-7316. 026028NUABOITI VLY CA NAL8INN0SU ED-HYUNDAI MOTOR AMERICA, 10550 TALBERT AVE, FOUNTAI03 6028BU ADDITIONAL INSURED -STRUCTURAL GROUP INC, 11800 MONARCH ST, GARDEN GROVE CA 92841-2113. 04 6028BU ADDITIONAL INSURED -CITY OF TEMECULA: MARGARITA RECREATION CENTER 05S6028BUTAD(}ITIONALMINSURED-THE' CITYEOFLCORONA, ITSIDIRECTORS, OFFICIALS, OFFICERS , TIO 400 5 VICENTIA AVENUE 400 S VICENTIA AVE, CORONA CA 92882-2187. 06 6028BOJ ADDINAL INSURED-CASCO CONTRACTORS LLC, 9850 IRVINE CENTER DR, IRVINE CA 92618-4353. 07 6028BU ADDITIONAL INSURED-CKE RESTAURANTS HOLDINGS INC, 6700 TOWER CIR 08E6028BL AUTOMOBILENLIABILITY-ADDITIONAL INSURED ENDORSEMENT CITY OF LOS ANGELES-DEPARTMENT OF WATER AND POWER -HARPER CONSTRUCTION COMPANY, INC., 9. 09 6028BUNADDITINALAINSURED-CBGgBUILDERS, 24 EXECUTIVE PARK STE 150, IRVINE CA 92614-2753. 10 6028BU ADDITIONAL INSURED-SOLANA BEACH CITY HALL, 635 S HIGHWAY 101, SOLANA BEACH CA 92075-2215. 11 6028BU ADDITIONAL INSURED -CITY OF GLENDORA RISK MANAGEMENT, 116 E FOOTHILL BLVD GLENDORA CA 92741-3380. 12 6028BU ADDITIONAL INSURED -SOUTH ORANGE COUNTY COMMUNITY COLLEGE DISTRICT, 13D6028BU ADDITIONALYINMISSION URED DLSIBBUOILDERS GENERAL9CONTR, 1975 N BATAVIA ST, ORANGE CA 92865-4107. 14 6028BU ADDITIONAL INSURED-1541 AND 1545 WILSHIRE SEIU 1721 HOLDINGS LLC, 1545 WILSHIRE BLVD STE 100 LOS ANGELES CA 90017-4510. 15 6028BU ADDITIONAL INSURED-1541 AND 1545 WILSHIRE SEIU 721 HOLDINGS LLC, 1545 WILSHIRE BLVD STE 100 LOS ANGELES CA 90017-4510. 16 6028BU ADDITIONAL INSURED-DLS BUILDERS GENERAL CONTRACTOR, 1975 N BATAVIA ST ORANGE CA 92865-4107. 17 6028BU ADDITIONAL INSURED -CITY OF MANHATTAN BEACH, 1400 HIGHLAND AVE, MANHATTAN BCH CA 90266-4756. 18 6028BU ADDITIONAL INSURED -CITY OF SAN MARCOS, I CIVIC CENTER DR, SAN MARCOS CA 92069-2918. 19 6028BU ADDITIONAL INSURED-2H CONSTRUCTION INC, 2653 WALNUT AVE, SIGNAL HILL CA 90755-1830. 20 6028BU ADDITIONAL INSURED -THE CITY OF SAN MARINO, 2200 HUNTINGTON DR, SAN MARINO CA 91108-2639. 21 6028BU ADDITIONAL INSURED-KILROY REALTY CORPORATION, 3780 KILROY ARPRT 22Y6028BU1AbDITIONALAINSURED-CIITY2OF8IRVINE, C/O EXIGIS RISK MANAGEMENT SERVICES PO BOX 947, MURRIETA CA 92564-0947. 23 6028BU ADDITIONAL INSURED -CITY OF INDIAN WELLS, 44950 ELDORADO DR, INDIAN WELLS CA 92210-7497. 24 6028BU.ADDITIONAL-INSURED-CITY OF SANTA & ATIMA, M85220 S DAISY AVE BLDG 96AB- E C/O ERSONAL VEHICLE SHARING, T. UNDER THE LIABILITY COVERAGE FOR CITY OF NT SERVICES; CITY OF SANTA ANA & ATIMA. 21351116091 155.3855 CA,2 a5-Z802 (a1.WN.) (o1a0254c) 13SX8 (n1W25vd) Agent: JAVIER MISIEGO Telephone: (714)772-3838 Prepared OCT 03 2025 61 F8-B92 This policy is issued by State Farm Mutual Automobile Insurance Company, MUTUAL CONDITIONS 1. Membership. While this policy is in force, the first insured shown on the Declarations Page is entitled to vote at all meetings of members and to receive dividends the Board of Directors in its discretion may declare in accordance with reasonable classifications and groupings of policyholders established by such Board, 2. No Contingent Liability. This policy is non -assessable, 3. Annual Meeting. The annual meeting of the members of the company shall be held at its home office at Bloomington, Illinois, on the second Monday of June at the hour of 10:00 A.M., unless the Board of Directors shall elect to change the time and place of such meeting, In which case, but not otherwise, due notice shall be mailed each member at the address disclosed in this policy at least 10 days prior thereto. In Witness Whereof, the State Farm Mutual Automobile Insurance Company has caused this policy to be signed by its President and Secretary at Bloomington, Illinois. Secretary President Important. .. California law requires us to provide you with information for filing complaints with the State Insurance Department regarding the coverage and service provided under this policy. Complaints should be filed only after you and Slag Farm or your agent or other company representative have failed to reach a satisfactory agreement on a problem. Please forward such complaints to; California Department of Insurance Consumer Services Division 300 South Spring Street Los Angeles, CA 90013 Or file a complaint through the Department of Insurance's Internet Web site (www,insurance.ca.gov) Or call toll free 1-800-927-HELP (4357) NOTICE We are required to furnish you with the following informatlaw 1. An automobile liability insurance company may cancel a policy before the end of the current policy period for reasons described in the provision titled Cancellation which N located in the General Terms section of your policy (refer to the Contents In the beginning of your policy for the page number). 2. An automobile liability insurance company may increase the premium or refuse to renew the policy for any of the following reasons: a. Accident involvement by an insured, and whether an insured Is at fault in the accident, b. A change in, or an addition of, an insured vehicle. c. A change In, or addition of, an insured under the policy. d, A change in the location of garaging of an insured vehicle, e. A change in the use of the insured vehicle. f. Convictions for violating any provision of the Vehicle Code or the Penal Code relating to the operation of a motor vehicle, g. The payment made by an insurer due to a claim filed by an insured or a third party. An automobile liability insurance company may increase the premium or refuse to renew the policy for reasons that are not listed above but which are lawful and not unfairly discriminatory. coo 010 DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 10/30/2025 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(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 NAME: PLATINUM INSURANCE GROUP INC PHONE (888) 752-8467 (A/C, No, Ext): FAX (801) 528-6563 (A/C, No): 34471495 PO BOX 13297 OGDEN UT 84412 E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC# INSURERA: Hartford Underwriters Insurance Company 30104 INSURED INSURER B : WESTERN AV INC INSURERC: 1521 E ORANGETHORPE AVE STE A INSURERD: FULLERTON CA 92831-5203 INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: 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. INSR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSR WVD MM/DDNYYY MM/DDNY COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $2,000,000 CLAIMS -MADE OCCUR DAMAGE TO RENTED $1 000 000 PREMISES Ea occurrence MED EXP (Any one person) $10,000 X General Liability A X X 34 SBA BU60LX 07/18/2025 07/18/2026 PERSONAL & ADV INJURY $2 000 000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $T,000,000 POLICY PRO- ❑ LOC JECT PRODUCTS - COMP/OPAGG $4,000,000 OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident BODILY INJURY (Per person) ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) HIRED NON -OWNED PROPERTY DAMAGE AUTOS AUTOS (Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE EXCESS LIAB CLAIMS- MADE AGGREGATE DED RETENTION $ WORKERS COMPENSATION PER I OTH- AND EMPLOYERS' LIABILITY STATUTE ER E.L. EACH ACCIDENT ANY Y/N PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? N/A E.L. DISEASE -EA EMPLOYEE (Mandatory in NH) If yes, describe under E.L. DISEASE - POLICY LIMIT DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Those usual to the Insured's Operations. CERTIFICATE HOLDER CANCELLATION City of Santa Ana SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED Attention: Heidi Chou BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED 215 S. Center St. M-85 IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Santa Ana CA 92701 �i,4eotll 6f © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD Tu Tran DuTralnysigned Nguyenby APPROVED Date: 2025.11.04 By Tu Tran Nguyen at 11:01 am, Nov 04, 2025 Nguyen 11:02:09-08,00' AGENCY CUSTOMER ID: LOC#: r� ryr �k+f - ( �fel ) � ADDITIONAL REMARKS SCHEDULE Page 2 of 2 AGENCY NAMED INSURED PLATINUM INSURANCE GROUP INC WESTERN AV INC 1521 E ORANGETHORPE AVE STE A POLICY NUMBER SEE ACORD 25 FULLERTON CA 92831-5203 CARRIER NAIC CODE SEE ACORD 25 EFFECTIVE DATE: SEE ACORD 25 ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM FORM NUMBER: ACORD 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE Certificate holder is an additional insured per the Business Liability Coverage Form SL3032 attached to this policy. Waiver of Subrogation applies in favor of the Certificate Holder per the Business Liability Coverage Form SL0000, attached to this policy. Coverage is primary and noncontributory per the Business Liability Coverage Form SL0000, attached to this policy. Notice of Cancellation will be provided in accordance with Form SL9013, attached to this policy. ACORD 101 (2014/01) © 2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Policy Change: THE HARTFORD Business Owner's Policy The following Additional Insured has been added as an Additional Insured - Vendors. City of Santa Ana, its City Council, officers, officials, employees, agents, and volunteers. Water Resources M85, 220 S DAISY AVE BLDG A, SANTA ANA, CA 92703 Policy is amended to revise the following Endorsement Forms reflecting the changes made to your policy. SPECTRUM SUPPLEMENTAL SC 00 02 10 18 SCHEDULE OF AUDITABLE Common COVERAGES SC 00 06 10 18 1 POLICY CHANGE Common Premium associated with this Policy Change has pro rata factor 0.717. Form SC 00 06 10 18 Page 2 of 2 Process Date: 10/29/2025 © 2018, The Hartford Policy Expiration Date: 07/18/2026 (May include copyrighted material of Insurance Services Office, Inc., with its permission) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. THE HARTFORD SPECTRUM SUPPLEMENTAL SCHEDULE OF AUDITABLE COVERAGES This schedule reflects only those classes and/or coverages that are subject to audit. POLICY NUMBER: 34 SBA BU60LX Revised: 10/29/2025 Entries herein, except as specifically provided elsewhere in this policy, do not modify any of the other provisions of this policy. Auditable Coverage Description: LOC 1, BLDG 1: 1592 N BATAVIA ST STE 20RANGE,CA 92867-3554 Class Code: 11081 Class Code Description: Technology Integration, Installation, Service or Repair Coverage Description Rating Basis Exposure Final Rate Liability and Med Exp (Premises/Completed Operations) Sales 1 187.000000 Products - Completed Operations Sales 1 6.000000 Technology Services Coverage Extension PremOps Sales 1 6.000000 Technology Services Coverage Extension Product Sales 1 1.000000 LOC 2, BLDG 1: 4636 E ELWOOD ST STE 12PHOENIX,AZ 85040-1963 Class Code: 11081 Class Code Description: Technology Integration, Installation, Service or Repair Coverage Description Rating Basis Exposure Final Rate Liability and Med Exp (Premises/Completed Operations) Sales 5,000,000 0.046000 Products - Completed Operations Sales 5,000,000 0.026000 Technology Services Coverage Extension PremOps Sales 5,000,000 0.001000 Technology Services Coverage Extension Product Sales 5,000,000 0.001000 LOC 3, BLDG 1: 1521 E ORANGETHORPE AVE STE AFULLERTON,CA 92831-5203 Class Code: 11081 Class Code Description: Technology Integration, Installation, Service or Repair Coverage Description Rating Basis Exposure Final Rate Business Income and Extra Expense Sales �J 10,000,000 0.024000 Form SC 00 02 10 18 Page 1 of 2 Process Date: 10/29/2025 © 2018, The Hartford Policy Expiration Date: 07/18/2026 (May include copyrighted material of Insurance Services Office, Inc., with its permission) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. THE HARTFORD Coverage Description Rating Basis Exposure Final Rate Business Income from Civil Authority Orders Sales 10,000,000 0.001000 Business Income from Off- Premises Operations Sales 10,000,000 0.001000 Business Income from Websites Sales 10,000,000 0.001000 Collapse Business Income Sales 10,000,000 0.001000 Employee Dishonesty Coverage - Excludes ERISA Compliance Sales 10,000,000 0.012000 Fraudulent Transfer Coverage Sales 10,000,000 0.002000 Interruption of Computer Operations Sales 10,000,000 0.002000 Liability and Med Exp (Premises/Completed Operations) Sales 10,000,000 0.200000 Limited Fungi, Bacteria or Virus Coverage Business Income Sales 10,000,000 0.001000 Newly Acquired or Constructed Property BI Sales 10,000,000 0.001000 Products - Completed Operations Sales 10,000,000 0.017000 Spoilage Business Income Sales 10,000,000 0.001000 Sump Overflow or Sump Pump Failure BI Sales 10,000,000 0.001000 Technology Services Coverage Extension PremOps Sales 10,000,000 0.006000 Technology Services Coverage Extension Product Sales 10,000,000 0.001000 Transit Business Income Sales 10,000,000 0.001000 Form SC 00 02 10 18 Page 2 of 2 Process Date: 10/29/2025 © 2018, The Hartford Policy Expiration Date: 07/18/2026 (May include copyrighted material of Insurance Services Office, Inc., with its permission) Policy Change: THE HARTFORD Business Owner's Policy The schedule associated with Waiver of Subrogation has been revised and modifies your Liability coverage. City of Fontana, the City and it's officials, officers, employees, agents and/or 8353 Sierra Ave, Fontana, CA 92335-3528 volunteers Waiver Name Overflow City of Brea Waiver Name Overflow 1 CIVIC CENTER CIR, BREA, CA 92821- 57922 Harper Construction Company, Inc. Waiver Name Overflow 2241 Kettner Blvd, Ste 300 San Diego, CA 92101-17692 Balfour Beatty Construction, LLC NAVFAC Southwest, NAVFAC Southwest 3100 McKinnon Street, Dallas, TX 75201 Balfour Beatty Construction, LLC W.E. O'Neil Construction Co. of California Waiver Name Overflow 300 North Continental Blvd., Suite 190 El Segundo, CA 90245 City of Torrance Waiver Name Overflow 3031 Torrance Blvd Torrance, CA 90503 City of Santa Ana , its City Council, officers, officials, employees, agents, and 220 S Daisy Ave Bldg A SANTA ANA CA i volunteers Water Resources M85 Waiver Name Overflow 92703 Policy is amended to revise the following Endorsement Forms reflecting the changes made to your policy. SPECTRUM SUPPLEMENTAL SC 00 02 10 18 SCHEDULE OF AUDITABLE Common COVERAGES i SC 00 06 10 18 POLICY CHANGE I Common I SL 30 03 10 18 1 WAIVER OF SUBROGATION I Liability I Premium associated with this Policy Change has pro rata factor 0.717. Form SC 00 06 10 18 Page 2 of 2 Process Date: 10/29/2025 © 2018, The Hartford Policy Expiration Date: 07/18/2026 (May include copyrighted material of Insurance Services Office, Inc., with its permission) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. THE HARTFORD SPECTRUM SUPPLEMENTAL SCHEDULE OF AUDITABLE COVERAGES This schedule reflects only those classes and/or coverages that are subject to audit. POLICY NUMBER: 34 SBA BU60LX Revised: 10/29/2025 Entries herein, except as specifically provided elsewhere in this policy, do not modify any of the other provisions of this policy. Auditable Coverage Description: LOC 1, BLDG 1: 1592 N BATAVIA ST STE 20RANGE,CA 92867-3554 Class Code: 11081 Class Code Description: Technology Integration, Installation, Service or Repair Coverage Description Rating Basis Exposure Final Rate Liability and Med Exp (Premises/Completed Operations) Sales 1 187.000000 Products - Completed Operations Sales 1 6.000000 Technology Services Coverage Extension PremOps Sales 1 6.000000 Technology Services Coverage Extension Product Sales 1 1.000000 LOC 2, BLDG 1: 4636 E ELWOOD ST STE 12PHOENIX,AZ 85040-1963 Class Code: 11081 Class Code Description: Technology Integration, Installation, Service or Repair Coverage Description Rating Basis Exposure Final Rate Liability and Med Exp (Premises/Completed Operations) Sales 5,000,000 0.046000 Products - Completed Operations Sales 5,000,000 0.026000 Technology Services Coverage Extension PremOps Sales 5,000,000 0.001000 Technology Services Coverage Extension Product Sales 5,000,000 0.001000 LOC 3, BLDG 1: 1521 E ORANGETHORPE AVE STE AFULLERTON,CA 92831-5203 Class Code: 11081 Class Code Description: Technology Integration, Installation, Service or Repair Coverage Description Rating Basis Exposure Final Rate Business Income and Extra Expense Sales �J 10,000,000 0.024000 Form SC 00 02 10 18 Page 1 of 2 Process Date: 10/29/2025 © 2018, The Hartford Policy Expiration Date: 07/18/2026 (May include copyrighted material of Insurance Services Office, Inc., with its permission) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. THE HARTFORD Coverage Description Rating Basis Exposure Final Rate Business Income from Civil Authority Orders Sales 10,000,000 0.001000 Business Income from Off- Premises Operations Sales 10,000,000 0.001000 Business Income from Websites Sales 10,000,000 0.001000 Collapse Business Income Sales 10,000,000 0.001000 Employee Dishonesty Coverage - Excludes ERISA Compliance Sales 10,000,000 0.012000 Fraudulent Transfer Coverage Sales 10,000,000 0.002000 Interruption of Computer Operations Sales 10,000,000 0.002000 Liability and Med Exp (Premises/Completed Operations) Sales 10,000,000 0.200000 Limited Fungi, Bacteria or Virus Coverage Business Income Sales 10,000,000 0.001000 Newly Acquired or Constructed Property BI Sales 10,000,000 0.001000 Products - Completed Operations Sales 10,000,000 0.017000 Spoilage Business Income Sales 10,000,000 0.001000 Sump Overflow or Sump Pump Failure BI Sales 10,000,000 0.001000 Technology Services Coverage Extension PremOps Sales 10,000,000 0.006000 Technology Services Coverage Extension Product Sales 10,000,000 0.001000 Transit Business Income Sales 10,000,000 0.001000 Form SC 00 02 10 18 Page 2 of 2 Process Date: 10/29/2025 © 2018, The Hartford Policy Expiration Date: 07/18/2026 (May include copyrighted material of Insurance Services Office, Inc., with its permission) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. IN THE HARTFORD WAIVER OF SUBROGATION This endorsement modifies insurance provided under the following: BUSINESS LIABILITY COVERAGE FORM Except as otherwise stated in this endorsement, the terms and conditions of the Policy apply. The following is added to Section E. LIABILITY AND MEDICAL EXPENSES GENERAL CONDITIONS: We waive any right of recovery we may have against: a. Any person or organization shown in the Declarations, or b. Any person or organization with whom you have a contract that requires such waiver. Form SL 30 03 10 18 Page 1 of 1 © 2018, The Hartford (May include copyrighted material of Insurance Services Office, Inc., with its permission) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. IN THE HARTFORD BLANKET ADDITIONAL INSURED BY CONTRACT This endorsement modifies insurance provided under the following: BUSINESS LIABILITY COVERAGE FORM Except as otherwise stated in this endorsement, the terms and conditions of the Policy apply. A. The following is added to Section C. WHO IS AN INSURED: Additional Insureds When Required By Written Contract, Written Agreement Or Permit The person(s) or organization(s) identified in Paragraphs a. through f. below are additional insureds when you have agreed, in a written contract or written agreement, or when required by a written permit issued by a state or governmental agency or subdivision or political subdivision that such person or organization be added as an additional insured on your Coverage Part, provided the injury or damage occurs subsequent to the execution of the contract or agreement, or the issuance of the permit. A person or organization is an additional insured under this provision only for that period of time required by the contract, agreement or permit. However, no such person or organization is an additional insured under this provision if such person or organization is included as an additional insured by any other endorsement issued by us and made a part of this Coverage Part. The insurance afforded to such additional insured will not be broader than that which you are required by the contract, agreement, or permit to provide for such additional insured. The insurance afforded to such additional insured only applies to the extent permitted by law. The limits of insurance that apply to additional insureds are described in Section D. LIABILITY AND MEDICAL EXPENSES LIMITS OF INSURANCE. How this insurance applies when other insurance is available to an additional insured is described in the Other Insurance Condition in Section E. LIABILITY AND MEDICAL EXPENSES GENERAL CONDITIONS. a. Vendors Any person(s) or organization(s) (referred to below as vendor), but only with respect to "bodily injury" or "property damage" arising out of "your products" which are distributed or sold in the regular course of the vendor's business and only if this Coverage Part provides coverage for "bodily injury" or "property damage" included within the "products -completed operations hazard". (1) The insurance afforded to the vendor is subject to the following additional exclusions: This insurance does not apply to: (a) "Bodily injury" or "property damage" for which the vendor is obligated to pay damages by reason of the assumption of liability in a contract or agreement. This exclusion does not apply to liability for damages that the vendor would have in the absence of the contract or agreement; (b) Any express warranty unauthorized by you; (c) Any physical or chemical change in the product made intentionally by the vendor; (d) Repackaging, except when unpacked solely for the purpose of inspection, demonstration, testing, or the substitution of parts under instructions from the manufacturer, and then repackaged in the original container; (e) Any failure to make such inspections, adjustments, tests or servicing as the vendor has agreed to make or normally undertakes to make in the usual course of business, in connection with the distribution or sale of the products; (f) Demonstration, installation, servicing or repair operations, except such operations performed at the vendor's premises in connection with the sale of the product; Form SL 30 32 06 21 Page 1 of 3 © 2021, The Hartford (May include copyrighted material of Insurance Services Office, Inc., with its permission) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. THE HARTFORD (g) Products which, after distribution or sale by you, have been labeled or relabeled or used as a container, part or ingredient of any other thing or substance by or for the vendor; or (h) "Bodily injury" or "property damage" arising out of the sole negligence of the vendor for its own acts or omissions or those of its employees or anyone else acting on its behalf. However, this exclusion does not apply to: (i) The exceptions contained in Paragraphs (d) or (f); or (ii) Such inspections, adjustments, tests or servicing as the vendor has agreed to make or normally undertakes to make in the usual course of business, in connection with the distribution or sale of the products. (2) This insurance does not apply to any insured person or organization from whom you have acquired such products, or any ingredient, part or container, entering into, accompanying or containing such products. b. Lessors Of Equipment (1) Any person or organization from whom you lease equipment; but only with respect to their liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by your maintenance, operation or use of equipment leased to you by such person or organization. (2) With respect to the insurance afforded to these additional insureds, this insurance does not apply to any "occurrence" which takes place after you cease to lease that equipment. c. Lessors Of Land Or Premises (1) Any person or organization from whom you lease land or premises, but only with respect to liability arising out of the ownership, maintenance or use of that part of the land or premises leased to you. (2) With respect to the insurance afforded to these additional insureds, this insurance does not apply to: (a) Any 'occurrence" which takes place after you cease to lease that land or be a tenant in that premises; or (b) Structural alterations, new construction or demolition operations performed by or on behalf of such person or organization. d. Architects, Engineers Or Surveyors (1) Any architect, engineer, or surveyor, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by your acts or omissions or the acts or omissions of those acting on your behalf: (a) In connection with your premises; (b) In the performance of your ongoing operations performed by you or on your behalf; or (c) In connection with "your work" and included within the "products -completed operations hazard", but only if: (i) The written contract, written agreement or permit requires you to provide such coverage to such additional insured; and (ii) This Coverage Part provides coverage for "bodily injury" or "property damage" included within the "products -completed operations hazard". (2) With respect to the insurance afforded to these additional insureds, the following additional exclusion applies: This insurance does not apply to "bodily injury", "property damage" or "personal and advertising injury" arising out of the rendering of or the failure to render any professional services, including: (i) The preparing, approving, or failure to prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders, change orders, designs or drawings and specifications; or (ii) Supervisory, surveying, inspection, architectural or engineering activities. This exclusion applies even if the claims allege negligence or other wrongdoing in the supervision, hiring, employment, training or monitoring of others by an insured, if the "bodily injury", "property Form SL 30 32 06 21 Page 2 of 3 © 2021, The Hartford (May include copyrighted material of Insurance Services Office, Inc., with its permission) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. THE HARTFORD damage", or "personal and advertising injury" arises out of the rendering of or the failure to render any professional service. e. State Or Governmental Agency Or Subdivision Or Political Subdivision Issuing Permit (1) Any state or governmental agency or subdivision or political subdivision, but only with respect to operations performed by you or on your behalf for which the state or governmental agency or subdivision or political subdivision has issued a permit. (2) With respect to the insurance afforded to these additional insureds, this insurance does not apply to: (a) "Bodily injury", "property damage" or "personal and advertising injury" arising out of operations performed for the federal government, state or municipality; or (b) "Bodily injury" or "property damage" included within the "products -completed operations hazard". f. Any Other Party (1) Any other person or organization who is not in one of the categories or classes listed above in Paragraphs a. through e. above, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by your acts or omissions or the acts or omissions of those acting on your behalf: (a) In the performance of your ongoing operations performed by you or on your behalf; (b) In connection with your premises owned by or rented to you; or (c) In connection with "your work" and included within the "products -completed operations hazard", but only if: (i) The written contract, written agreement or permit requires you to provide such coverage to such additional insured; and (ii) This Coverage Part provides coverage for "bodily injury" or "property damage" included within the "products -completed operations hazard". (2) With respect to the insurance afforded to these additional insureds, the following additional exclusion applies: This insurance does not apply to "bodily injury", "property damage" or "personal and advertising injury" arising out of the rendering of, or the failure to render, any professional architectural, engineering or surveying services, including: (a) The preparing, approving, or failure to prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders, change orders, designs or drawings and specifications; or (b) Supervisory, surveying, inspection, architectural or engineering activities. This exclusion applies even if the claims allege negligence or other wrongdoing in the supervision, hiring, employment, training or monitoring of others by an insured, if the "bodily injury", "property damage", or "personal and advertising injury" arises out of the rendering of or the failure to render any professional service described in Paragraphs f.(2)(a) or f.(2)(b) above. Form SL 30 32 06 21 Page 3 of 3 © 2021, The Hartford (May include copyrighted material of Insurance Services Office, Inc., with its permission) THE HARTFORD (2) Premises Rented To You That is fire, lightning or explosion insurance for premises rented to you or temporarily occupied by you with permission of the owner; (3) Tenant Liability That is insurance purchased by you to cover your liability as a tenant for "property damage" to premises rented to you or temporarily occupied by you with permission of the owner; (4) Aircraft, Auto Or Watercraft If the loss arises out of the maintenance or use of aircraft, "autos" or watercraft to the extent not subject to Exclusion g. of Section B. Exclusions. (5) Property Damage To Borrowed Equipment Or Use Of Elevators If the loss arises out of "property damage" to borrowed equipment or the use of elevators to the extent not subject to Exclusion k. of Section B. Exclusions. (6) When You Are Added As An Additional Insured To Other Insurance That is other insurance available to you covering liability for damages arising out of the premises or operations, or products and completed operations, for which you have been added as an additional insured by that insurance; or (7) When You Add Others As An Additional Insured To This Insurance That is other insurance available to an additional insured. However, the following provisions apply to other insurance available to any person or organization who is an additional insured under this Coverage Part: (a) Primary Insurance When Required By Contract This insurance is primary if you have agreed in a written contract, written agreement or permit that this insurance be primary. If other insurance is also primary, we will share with all that other insurance by the method described in c. below. (b) Primary And Non -Contributory To Other Insurance When Required By Contract If you have agreed in a written contract, written agreement or permit that this insurance is primary and non-contributory with the additional insured's own insurance, this insurance is primary and we will not seek contribution from that other insurance. Paragraphs (a) and (b) do not apply to other insurance to which the additional insured has been added as an additional insured. When this insurance is excess, we will have no duty under this Coverage Part to defend the insured against any "suit" if any other insurer has a duty to defend the insured against that "suit". If no other insurer defends, we will undertake to do so, but we will be entitled to the insured's rights against all those other insurers. When this insurance is excess over other insurance, we will pay only our share of the amount of the loss, if any, that exceeds the sum of: (1) The total amount that all such other insurance would pay for the loss in the absence of this insurance; and (2) The total of all deductible and self -insured amounts under all that other insurance. We will share the remaining loss, if any, with any other insurance that is not described in this Excess Insurance provision and was not bought specifically to apply in excess of the Limits of Insurance shown in the Declarations of this Coverage Part. c. Method Of Sharing If all the other insurance permits contribution by equal shares, we will follow this method also. Under this approach, each insurer contributes equal amounts until it has paid its applicable limit of insurance or none of the loss remains, whichever comes first. Form SL 00 00 10 18 Page 17 of 22 © 2018, The Hartford (May include copyrighted material of Insurance Services Office, Inc., with its permission) THE HARTFORD If any of the other insurance does not permit contribution by equal shares, we will contribute by limits. Under this method, each insurer's share is based on the ratio of its applicable limit of insurance to the total applicable limits of insurance of all insurers. 7. Transfer Of Rights Of Recovery Against Others To Us a. Transfer Of Rights Of Recovery If the insured has rights to recover all or part of any payment, including Supplementary Payments, we have made under this Coverage Part, those rights are transferred to us. The insured must do nothing after loss to impair them. At our request, the insured will bring "suit" or transfer those rights to us and help us enforce them. This condition does not apply to Medical Expenses Coverage. b. Waiver Of Rights Of Recovery (Waiver Of Subrogation) If the insured has waived any rights of recovery against any person or organization for all or part of any payment, including Supplementary Payments, we have made under this Coverage Part, we also waive that right, provided the insured waived their rights of recovery against such person or organization in a contract, agreement or permit that was executed prior to the injury or damage. F. LIABILITY AND MEDICAL EXPENSES DEFINITIONS 1. "Advertisement" means a notice that is broadcast or published to the general public or specific market segments about your goods, products or services for the purpose of attracting customers or supporters. For the purpose of this definition: a. Notices that are published include material placed on the Internet or on similar electronic means of communication; and b. Regarding web sites, only that part of a web site that is about your goods, products or services for the purpose of attracting customers or supporters is considered an advertisement. 2. "Advertising idea" means any idea for an "advertisement". 3. "Asbestos hazard" means an exposure or threat of exposure to the actual or alleged properties of asbestos and includes the mere presence of asbestos in any form. 4. "Auto" means: a. A land motor vehicle, trailer or semi -trailer designed for travel on public roads, including any attached machinery or equipment; or b. Any other land vehicle that is subject to a compulsory or financial responsibility law or other motor vehicle insurance or motor vehicle registration law where it is licensed or principally garaged. However, "auto" does not include "mobile equipment". 5. "Bodily injury" means physical: a. Injury; b. Sickness; or c. Disease sustained by a person and, if arising out of the above, mental anguish or death at any time. 6. "Coverage territory" means: a. The United States of America (including its territories and possessions), Puerto Rico and Canada; b. International waters or airspace, but only if the injury or damage occurs in the course of travel or transportation between any places included in a. above; c. All other parts of the world if the injury or damage arises out of: (1) Goods or products made or sold by you in the territory described in a. above; (2) The activities of a person whose home is in the territory described in a. above, but is away for a short time on your business; or Form SL 00 00 10 18 Page 18 of 22 © 2018, The Hartford (May include copyrighted material of Insurance Services Office, Inc., with its permission) THE HARTFORD (3) "Personal and advertising injury" offenses that take place through the Internet or similar electronic means of communication. provided the insured's responsibility to pay damages is determined in the United States of America (including its territories and possessions), Puerto Rico or Canada, in a "suit" on the merits according to the substantive law in such territory, or in a settlement we agree to. 7. "Electronic data" means information, facts or computer programs stored as or on, created or used on, or transmitted to or from computer software (including systems and applications software), on hard or floppy disks, CD-ROMs, tapes, drives, cells, data processing devices or any other repositories of computer software which are used with electronically controlled equipment. The term computer programs, referred to in the foregoing description of "electronic data", means a set of related electronic instructions which direct the operations and functions of a computer or device connected to it, which enable the computer or device to receive, process, store, retrieve or send data. 8. "Employee" includes a "leased worker". "Employee" does not include a "temporary worker". 9. "Executive officer" means a person holding any of the officer positions created by your charter, constitution, by- laws or any other similar governing document. 10. "Hostile fire" means one which becomes uncontrollable or breaks out from where it was intended to be. 11. "Impaired property" means tangible property, other than "your product" or "your work", that cannot be used or is less useful because: a. It incorporates "your product" or "your work" that is known or thought to be defective, deficient, inadequate or dangerous; or b. You have failed to fulfill the terms of a contract or agreement; if such property can be restored to use by: a. The repair, replacement, adjustment or removal of "your product" or "your work"; or b. Your fulfilling the terms of the contract or agreement. 12. "Insured contract" means: a. A contract for a lease of premises. However, that portion of the contract for a lease of premises that indemnifies any person or organization for damage by fire, lightning or explosion to premises while rented to you or temporarily occupied by you with permission of the owner is subject to the Damage To Premises Rented To You limit described in Section D. Liability And Medical Expenses Limits Of Insurance. b. A sidetrack agreement; c. Any easement or license agreement, including an easement or license agreement in connection with construction or demolition operations on or within 50 feet of a railroad; d. Any obligation, as required by ordinance, to indemnify a municipality, except in connection with work for a municipality; e. An elevator maintenance agreement; or f. That part of any other contract or agreement pertaining to your business (including an indemnification of a municipality in connection with work performed for a municipality) under which you assume the tort liability of another party to pay for "bodily injury" or "property damage" to a third person or organization. Tort liability means a liability that would be imposed by law in the absence of any contract or agreement. Paragraph f. includes that part of any contract or agreement that indemnifies a railroad for "bodily injury" or "property damage" arising out of construction or demolition operations within 50 feet of any railroad property and affecting any railroad bridge or trestle, tracks, road -beds, tunnel, underpass or crossing. However, Paragraph f. does not include that part of any contract or agreement: (1) That indemnifies an architect, engineer or surveyor for injury or damage arising out of: (a) Preparing, approving or failing to prepare or approve maps, shop drawings, opinions, reports, surveys, field orders, change orders, designs or drawings and specifications; or (b) Giving directions or instructions, or failing to give them, if that is the primary cause of the injury or damage; or Form SL 00 00 10 18 Page 19 of 22 © 2018, The Hartford (May include copyrighted material of Insurance Services Office, Inc., with its permission) THE HARTFORD (2) Under which the insured, if an architect, engineer or surveyor, assumes liability for an injury or damage arising out of the insured's rendering or failure to render professional services, including those listed in (1) above and supervisory, inspection, architectural or engineering activities. 13. "Leased worker" means a person leased to you by a labor leasing firm under an agreement between you and the labor leasing firm, to perform duties related to the conduct of your business. "Leased worker" does not include a "temporary worker". 14. "Loading or unloading" means the handling of property: a. After it is moved from the place where it is accepted for movement into or onto an aircraft, watercraft or "auto"; b. While it is in or on an aircraft, watercraft or "auto"; or c. While it is being moved from an aircraft, watercraft or "auto" to the place where it is finally delivered; but "loading or unloading" does not include the movement of property by means of a mechanical device, other than a hand truck, that is not attached to the aircraft, watercraft or "auto". 15. "Mobile equipment" means any of the following types of land vehicles, including any attached machinery or equipment: a. Bulldozers, farm machinery, forklifts and other vehicles designed for use principally off public roads; b. Vehicles maintained for use solely on or next to premises you own or rent; c. Vehicles that travel on crawler treads; d. Vehicles, whether self-propelled or not, on which are permanently mounted: (1) Power cranes, shovels, loaders, diggers or drills; or (2) Road construction or resurfacing equipment such as graders, scrapers or rollers; e. Vehicles not described in a., b., c., or d. above that are not self-propelled and are maintained primarily to provide mobility to permanently attached equipment of the following types: (1) Air compressors, pumps and generators, including spraying, welding, building cleaning, geophysical exploration, lighting and well servicing equipment; or (2) Cherry pickers and similar devices used to raise or lower workers; f. Vehicles not described in a., b., c., or d. above maintained primarily for purposes other than the transportation of persons or cargo. However, self-propelled vehicles with the following types of permanently attached equipment are not "mobile equipment" but will be considered "autos": (1) Equipment, of at least 1,000 pounds gross vehicle weight, designed primarily for: (a) Snow removal; (b) Road maintenance, but not construction or resurfacing; or (c) Street cleaning; (2) Cherry pickers and similar devices mounted on automobile or truck chassis and used to raise or lower workers; and (3) Air compressors, pumps and generators, including spraying, welding, building cleaning, geophysical exploration, lighting and well servicing equipment. However, "mobile equipment" does not include any land vehicle that is subject to a compulsory or financial responsibility law or other motor vehicle insurance or motor vehicle registration law where they are licensed or principally garaged. Land vehicles subject to a compulsory or financial responsibility law or other motor vehicle insurance law or motor vehicle registration law are considered "autos". 16. "Occurrence" means an accident, including continuous or repeated exposure to substantially the same general harmful conditions. 17. "Personal and advertising injury" means injury, including consequential "bodily injury", arising out of one or more of the following offenses: Form SL 00 00 10 18 Page 20 of 22 © 2018, The Hartford (May include copyrighted material of Insurance Services Office, Inc., with its permission) A� " CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDIYYYY) 01 /16/2026 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 Melanie Duarte NAME: StateFarm Javier Misiego AHOEICNNo Ext : 714-772-3838 A/� No): 714-808-6431 227 20th St Suite 104 ADDRESS: Melanie.a.duarte.vadk7j@statefarm.com INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: State Farm Mutual Automobile Insurance Company 25178 Newport Beach CA 92663 INSURED INSURER B: State Farm Fire and Casualty Company 25143 INSURER C : State Farm General Insurance Company 25151 WESTERN A/V INC INSURER D : 1521 E ORANGETHORPE AVE STE A INSURER E: FULLERTON CA 92831 INSURER F : COVERAGES CERTIFICATE NUMBER: 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. INSR LTR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF MM/DDIYYYY POLICY EXP MM/DDIYYYY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ C CLAIMS-MADE1:1 OCCUR DAMAGE TO RENTED PREMISES Ea occurrence $ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY ❑ PRO ❑ LOC JECT PRODUCTS - COMP/OP AGG $ $ OTHER: AUTOMOBILE LIABILITY Y Y 661 2954-E13-75 11/13/2025 11/13/2026 COMBINEDINGLELIMIT a Ea ccidents $ 1,000,000 BODILY INJURY (Per person) $ X ANY AUTO A X OWNED �/ SCHEDULED /� AUTOS ONLY /� AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ X HIRED X NON -OWNED AUTOS ONLY /� AUTOS ONLY X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000 AGGREGATE $ 5,000,000 C EXCESS LIAB CLAIMS -MADE N/A N/A 92-XC-0351-6 12/14/2025 12/14/2026 DED RETENTION $ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y/ N OFFICER/MEMBER EXCLUDED? ❑ (Mandatory in NH) NIA Y g2-MW-H628-7 01/01/2026 01/01/2027 X PER STATUTE ERH E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000 B SURETY BOND 92-KN-M222-7 06/16/2023 06/16/2026 $25,000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) AUDIO VISUAL SYSTEMS INTEGRATION Business Location 1521 E ORANGETHORPE AVE STE A FULLERTON CA 92831 It is agreed that is is the intention of the Company to provide 30 days written notice prior to the cancellation of the policy designated in this certificate. However, the Company assumes no liability for failure to do so. CERTIFICATE HOLDER CANCELLATION City of Santa Ana Attention: Heidi Chou 215 S. Center St. M-85 Santa Ana CA 92701 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE @ 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD 1001486 132849.13 04-22-2020 DATE (MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 12/29/2025 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(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 NAME: PLATINUM INSURANCE GROUP INC 34471495 PHONE (888)752-8467 (A/C, No, Ext): Fax (801)528-6563 (A/C, No): PO BOX 13297 OGDEN UT 84412 E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC# INSURER A: Hartford Underwriters Insurance Company 30104 INSURED INSURER B : WESTERN AV INC INSURER C 1521 E ORANGETHORPE AVE STE A INSURERD: FULLERTON CA 92831-5203 INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: 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. INSR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSR WVD MM/DD/YYYY MM/DD/Y YYY COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $2,000,000 CLAIMS -MADE OCCUR DAMAGE TO RENTED $1,000,000 PREMISES Ea occurrence MED EXP (Any one person) $10,000 X General Liability A X X 34 SBA BU60LX 07/18/2025 07/18/2026 PERSONAL & ADV INJURY $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $4,000,000 POLICY � PRO- ❑ LOC JECT PRODUCTS - COMP/OPAGG $4,000,000 OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident BODILY INJURY (Per person) ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) HIRED NON -OWNED PROPERTY DAMAGE AUTOS AUTOS (Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE AGGREGATE EXCESS LIAB CLAIMS- MADE DED RETENTION $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS' LIABILITY AT ER E.L. EACH ACCIDENT ANY Y/N PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? NIA E.L. DISEASE -EA EMPLOYEE (Mandatory in NH) If yes, describe under E.L. DISEASE - POLICY LIMIT DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS /LOCATIONS /VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Those usual to the Insured's Operations. CERTIFICATE HOLDER CANCELLATION City of Santa Ana SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED Water Resources M85 BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED 220 S DAISY AVE BLDG A IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE SANTA ANA CA 92703 �6c�i� � L 6lDLa�rr�Gr�> ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: LOC#: ADDITIONAL REMARKS SCHEDULE Page 2 of 2 AGENCY NAMED INSURED PLATINUM INSURANCE GROUP INC WESTERN AV INC 1521 E ORANGETHORPE AVE STE A POLICY NUMBER SEE ACORD 25 FULLERTON CA 92831-5203 CARRIER NAIC CODE SEE ACORD 25 EFFECTIVE DATE: SEE ACORD 25 ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM FORM NUMBER: ACORD 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE Certificate holder is an additional insured per the Business Liability Coverage Form SL3032 attached to this policy. Waiver of Subrogation applies in favor of the Certificate Holder per the Business Liability Coverage Form SL0000, attached to this policy. Coverage is primary and noncontributory per the Business Liability Coverage Form SL0000, attached to this policy. Notice of Cancellation will be provided in accordance with Form SL9013, attached to this policy. ACORD 101 (2014/01) © 2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Policy Change: THEmd HARTFORD Business Owner's Policy The schedule associated with Waiver of Subrogation has been revised and modifies your Liability coverage. Person or Organizatio .. City of Fontana, the City and it's officials, officers, employees, agents and/or 8353 Sierra Ave, Fontana, CA 92335-3528 volunteers Waiver Name Overflow City of Brea Waiver Name Overflow 1 CIVIC CENTER CIR, BREA, CA 92821- 57922 Harper Construction Company, Inc. Waiver Name Overflow 2241 Kettner Blvd, Ste 300 San Diego, CA 92101-17692 3100 McKinnon Street, Dallas, TX 75201 Balfour Beatty Construction, LLC NAVFAC Southwest, NAVFAC Southwest Balfour Beatty Construction, LLC W.E. O'Neil Construction Co. of California Waiver Name Overflow 300 North Continental Blvd., Suite 190 El Segundo, CA 90245 City of Torrance Waiver Name Overflow 3031 Torrance Blvd Torrance, CA 90503 City of Santa Ana , its City Council, officers, officials, employees, agents, and 215 S. Center St., M-85, Santa Ana, CA volunteers Water Resources M85 Waiver Name Overflow 92701 City of Encinitas Waiver Name Overflow 505 S VULCAN AVE, ENCINITAS, CA 92024 2H Construction, Inc Waiver Name Overflow 2653 WALNUT AVE, SIGNAL HILL, CA 90755 City of Palos Verdes Estates Waiver Name Overflow 340 PALOS VERDES DR W, PALOS VERDES ESTATES CA 90274-1270 The City of Corona, its directors, officials, officers, employees, agents and 400 S VICENTIA AVE CORONA, CA 92882 volunteers Waiver Name Overflow City of Burbank PROCUREMENT SERVICES PO Box 6459 301 East Olive Avenue, Ste 305 Burbank, CA 91510-6459 Pub Construction Inc, contractor and its officers, owners and employees, the Project Owner and all of its directors, property managers, employees, agents and 23545 Palomino Drive, #104 Diamond Bar, representatives, including Architect and Architects consultants and all additional CA 91765 parties named in the Contract 411 W Ocean Boulevard 7th Floor, Long The City of Long Beach Waiver Name Overflow Beach, CA 90802 Coachella Valley Water Disctict CVWD, its directors, officials, officers, employees, PO Box 1058 COACHELLA, CA 92236 agents, and volunteers Waiver Name Overflow Record Steel & Construction Inc. dba RSCI and US Army Corps of Engineers, Los 333 Rossi Street Suite 20, Boise, ID 83708 Angeles District Waiver Name Overflow CITY OF BUENA PARK, CITY MANAGER, CITY HALL, ITS CITY, ELECTED 6650 BEACH BLVD BUENA PARK CA OFFICIALS, OFFICERS, EMPLOYEES AND AGENTS Waiver Name Overflow 90621-2985 Hi -Tech Cabling, Inc., General Contractor AND project owner(s) Waiver Name 1045 N. Armando St. #G I Anaheim, CA Overflow 92806 1200 E CALIFORNIA BLVD. PASADENA. CA California Institute of Technology Caltech, its employees, officers and directors 91125 1 The following Additional Insured has been associated with Additional Insured - Owners, Lessees, or Contractors - Ongoing Operations - Scheduled Person or Organization has been revised. Form SC 00 06 10 18 Page 2 of 3 Process Date: 01/13/2026 © 2018, The Hartford Policy Expiration Date: 07/18/2026 (May include copyrighted material of Insurance Services Office, Inc., with its permission) Policy Change: THEmA HARTFORD Business Owner's Policy City of Santa Ana, Its City Council, Officers, Officials, 220 South Daisy Avenue, Employees, Agents, and Volunteers. Water Resources M85, Santa Ana, CA 92703 Audio Visual Systems 215 S CENTER ST # M-85, SANTA ANA, CA 92703-4395 The following Additional Insured has been associated with Additional Insured - Vendors has been revised. City of Santa Ana, its City Council, officers, officials, employees, agents, and volunteers. Water Resources M85, 215 S CENTER ST # M-85, SANTA ANA, CA 92703-4395 Policy is amended to revise the following Endorsement Forms reflecting the changes made to your policy. Common Liability Premium associated with this Policy Change has pro rata factor 0.509. Form SC 00 06 10 18 Page 3 of 3 Process Date: 01/13/2026 © 2018, The Hartford Policy Expiration Date: 07/18/2026 (May include copyrighted material of Insurance Services Office, Inc., with its permission) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. THE HARTFORD WAIVER OF SUBROGATION This endorsement modifies insurance provided under the following: BUSINESS LIABILITY COVERAGE FORM Except as otherwise stated in this endorsement, the terms and conditions of the Policy apply. The following is added to Section E. LIABILITY AND MEDICAL EXPENSES GENERAL CONDITIONS: We waive any right of recovery we may have against: a. Any person or organization shown in the Declarations, or b. Any person or organization with whom you have a contract that requires such waiver. Form SL 30 03 10 18 Page 1 of 1 © 2018, The Hartford (May include copyrighted material of Insurance Services Office, Inc., with its permission) CMP 4787 YPJ Policy No. 661 2954-E13-75 61F8—FB8A Page 1 of 1 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY CMP-4787 WAIVER OF TRANSFER OF RIGHTS OR RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: BUSINESSOWNERS COVERAGE FORM SCHEDULE Policy Number: 661 2954-E13-75 Named Insured: WESTERN A/V INC 1592 N BATAVIA ST STE 2 ORANGE CA 92867-3554 Name And Address Of Person Or Organization: City of Santa Ana, its City Council, officers, officials, employees, agents, and volunteers Attention: Heidi Chou 215 S. Center St. M-85 Santa Ana CA 92701 The following is added to Paragraph 10.b. of SECTION I AND SECTION II — COMMON POLICY CONDITIONS: We waive any right of recovery we may have against the person or organization shown in the Schedule because of payments we make for injury or damage arising out of: a. Your ongoing operations; or b. "Your work" done under contract with that person or organization and included in the "products - completed operations hazard". This waiver applies only to the person or organization shown in the Schedule. All other policy provisions apply. CMP-4787 1006225 137715.1 11-19-2013 ©, Copyright, State Farm Mutual Automobile Insurance Company, 2008 Includes copyrighted material of Insurance Services Office, Inc., with its permission. YPJ Policy No. 661 2954-E13-75 61F8—FB8A CMP-4786.1 Page 1 of 2 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CMP-4786.1 ADDITIONAL INSURED — OWNERS, LESSEES, OR CONTRACTORS (Scheduled) This endorsement modifies insurance provided under the following: BUSINESSOWNERS COVERAGE FORM SCHEDULE Policy Number: 661 2954-E13-75 Named Insured: WESTERN A/V INC 1592 N BATAVIA ST STE 2 ORANGE CA 92867-3554 Name And Address Of Additional Insured Person Or Organization: City of Santa Ana, its City Council, officers, officials, employees, agents, and volunteers Attention: Heidi Chou 215 S. Center St. M-85 Santa Ana CA 92701 1. SECTION II — WHO IS AN INSURED of SECTION II — LIABILITY is amended to in- clude, as an additional insured, any person or organization shown in the Schedule, but only with respect to liability for "bodily injury", "property damage", or "personal and advertis- ing injury" caused, in whole or in part, by: a. Ongoing Operations (1) Your acts or omissions; or (2) The acts or omissions of those acting on your behalf; in the performance of your ongoing opera- tions for that additional insured; or b. Products — Completed Operations "Your work" performed for that additional insured and included in the "products - completed operations hazard". However, Paragraph 1. above is subject to the following: a. The insurance afforded to the additional insured only applies to the extent permit- ted by law; b. If coverage provided to the additional in- sured is required by a contract or agree- ment, the insurance provided to the additional insured will not be broader than that which you are required by the contract or agreement to provide for such addition- al insured; and c. If the contract or agreement between you and the additional insured is governed by California Civil Code Section 2782 or 2782.05, the insurance provided to the additional insured is the lesser of that which: (1) Is allowed for the satisfaction of a de- fense or indemnity obligation by Cali- fornia Civil Code Section 2782 or 2782.05 for your sole liability; or (2) You are required by contract or agreement to provide for such addi- tional insured. We have no duty to defend or indemnify the additional insured under this endorsement un- til a claim or "suit" is tendered to us. ©, Copyright, State Farm Mutual Automobile Insurance Company, 2013 Includes copyrighted material of Insurance Services Office, Inc., with its permission. CONTINUED CMP-4786.1 Page 2 of 2 2. Any insurance provided to the additional in- sured shall only apply with respect to a claim made or a "suit' brought for damages for which you are provided coverage. 3. With respect to the insurance afforded to the additional insured, the following is added to SECTION II — LIMITS OF INSURANCE: If coverage provided to the additional insured is required by contract or agreement, the most we will pay on behalf of the additional insured will be the lesser of the amount of insurance: a. Required by the contract or agreement; or b. Available under the applicable Limits Of Insurance shown in the Declarations. This endorsement shall not increase the ap- plicable Limits Of Insurance shown in the Declarations. 4. With respect to the insurance afforded to the additional insured, the following is added to Paragraph 3. Duties In The Event Of Occur- rence, Offense, Claim Or Suit of SECTION II — GENERAL CONDITIONS: The additional insured must: a. See to it that we are notified as soon as practicable of an "occurrence" or an of- fense which may result in a claim. To the extent possible, notice should include: (1) How, when and where the "occur- rence" or offense took place; (3) The nature and location of any injury or damage arising out of the "occur- rence" or offense; b. Tender the defense and indemnity of any claim or "suit' to us and to all other insur- ers who may have insurance potentially available to the additional insured; and c. Agree to make available any other insur- ance the additional insured has for de- fense or damages for which we would provide coverage under SECTION II — LIABILITY. 5. With respect to the insurance afforded the ad- ditional insured, the following replaces SEC- TION II —LIABILITY of Paragraph 7. Other Insurance of SECTION I AND SECTION II — COMMON POLICY CONDITIONS: a. This insurance is primary to and will not seek contribution from any other insurance available to the additional insured, provided that the additional insured is a named in- sured under such other insurance. b. Regardless of any agreement between you and the additional insured, this insur- ance is excess over any other insurance whether primary, excess, contingent or on any other basis for which the additional in- sured has been added as an additional in- sured on other policies. There will be no refund of premium in the event this endorsement is cancelled. (2) The names and addresses of any in- jured persons and witnesses; and All other policy provisions apply. CMP-4786.1 1007033 148011 08-21-2014 ©, Copyright, State Farm Mutual Automobile Insurance Company, 2013 Includes copyrighted material of Insurance Services Office, Inc., with its permission. WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 (Ed. 4-84) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - CALIFORNIA We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. The additional premium for this endorsement shall be otherwise due on such remuneration. Person or Organization City of Santa Ana, its City Council, officers, officials, employees, agents, and volunteers Attention: Heidi Chou 215 S. Center St. M-85 Santa Ana CA 92701 5 % of the California workers' compensation premium Schedule Job Description Contract: $200 This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective 01- 01- 2 5 Insured WESTERN A/V Policy No. 92-Mw-H628-7 Endorsement No. Insurance Company State Farm Fire and Casualty Company Countersigned By WC 04 03 06 (Ed. 4-84) 1007722 124282.2 01-25-2019