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2022/08/09 Jacob Green & Associates08/12/2022 Great Park Insurance Services, Inc. 10 Corporate Park Suite 130 Irvine CA 92606 GPI House (949) 387-3242 (888) 370-4994 daniel@greatparkinsurance.com Jacob Green & Associates Hiscox 003030 BTIS CL2281202625 A UDC-5219378-EO-22 08/09/2022 08/09/2023 B GXS0008736 08/09/2022 08/09/2023 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. INSURER(S) AFFORDING COVERAGE INSURER F : INSURER E : INSURER D : INSURER C : INSURER B : INSURER A : NAIC # NAME:CONTACT (A/C, No):FAX E-MAILADDRESS: PRODUCER (A/C, No, Ext):PHONE INSURED REVISION NUMBER:CERTIFICATE NUMBER:COVERAGES 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). 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. OTHER: (Per accident) (Ea accident) $ $ N / A SUBR WVD ADDL INSD 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. $ $ $ $PROPERTY DAMAGE BODILY INJURY (Per accident) BODILY INJURY (Per person) COMBINED SINGLE LIMIT AUTOS ONLY AUTOSAUTOS ONLY NON-OWNED SCHEDULEDOWNED ANY AUTO AUTOMOBILE LIABILITY Y / N WORKERS COMPENSATION AND EMPLOYERS' LIABILITY OFFICER/MEMBER EXCLUDED? (Mandatory in NH) DESCRIPTION OF OPERATIONS below If yes, describe under ANY PROPRIETOR/PARTNER/EXECUTIVE $ $ $ E.L. DISEASE - POLICY LIMIT E.L. DISEASE - EA EMPLOYEE E.L. EACH ACCIDENT EROTH-STATUTEPER LIMITS(MM/DD/YYYY)POLICY EXP(MM/DD/YYYY)POLICY EFFPOLICY NUMBERTYPE OF INSURANCELTRINSR DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) EXCESS LIAB UMBRELLA LIAB $EACH OCCURRENCE $AGGREGATE $ OCCUR CLAIMS-MADE DED RETENTION $ $PRODUCTS - COMP/OP AGG $GENERAL AGGREGATE $PERSONAL & ADV INJURY $MED EXP (Any one person) $EACH OCCURRENCE DAMAGE TO RENTED $PREMISES (Ea occurrence) COMMERCIAL GENERAL LIABILITY CLAIMS-MADE OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO-JECT LOC CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) CANCELLATION AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. CERTIFICATE HOLDER The ACORD name and logo are registered marks of ACORD HIRED AUTOS ONLY 2,000,000 2,000,000 X X X X X X X X Hiscox 10200 10200 C UDC-5219378-EO-22 08/09/2022 08/09/2023 Each Claim $ 2,000,000 Aggregate $ 2,000,000 1,000,000 100,000 5,000 1,000,000 2,000,000 S/T Gen. Agg. 13217 Jamboree Road 248 Tustin CA 92782 Additional Insured: COUNTY OF ORANGE SHERIFF-CORONER DEPARTMENT 550 N FLOWER ST SANTA ANA CA 92703 COUNTY OF ORANGE SHERIFF-CORONER DEPARTMENT 550 N FLOWER ST SANTA ANA CA 92703 CITY OF PLACENTIA 401 E CHAPMAN AVE PLACENTIIA CA 92870 CITY OF PLACENTIA 401 E CHAPMAN AVE PLACENTIIA CA 92870 CITY OF SAN CLEMENTE 910 CALLE NEGOCIO SAN CLEMENTE CA 92673 CITY OF SAN CLEMENTE 910 CALLE NEGOCIO SAN CLEMENTE CA 92673 CITY OF STOCKTON 425 N EL DORADO ST STOCKTON CA 92503 CITY OF STOCKTON 425 N EL DORADO ST STOCKTON CA 92503 CITY OF TUCSON 255 W ALAMEDA 6TH FLOOR TUCSON AZ 85701 CITY OF TUCSON 255 W ALAMEDA 6TH FLOOR TUCSON AZ 85701 CITY OF VACAVILLE 650 MERCHANT ST VACAVILLE CA 95688 CITY OF VACAVILLE 650 MERCHANT ST VACAVILLE CA 95688 CITY OF GARDEN GROVE 11222 ACACIA PKWY GARDEN GROVE CA 92840 CITY OF GARDEN GROVE 11222 ACACIA PKWY GARDEN GROVE CA 92840 Professional Liability 08/17/2022 CITY OF CORONA 400 S VICENTIA AVE SUITE 155 CORONA CA, 92882 CITY OF CORONA 400 S VICENTIA AVE SUITE 155 CORONA CA, 92882 City Of Monrovia 415 S Ivy Ave Monrovia, CA 91016 City Of Monrovia 415 S Ivy Ave Monrovia, CA 91016 City Of Montebello 1600 W Beverly Blvd Montebello, CA 90640 City Of Montebello 1600 W Beverly Blvd Montebello, CA 90640 City Of Pico Rivera 6615 Passons Blvd Pico Rivera, CA 90660 City Of Pico Rivera 6615 Passons Blvd Pico Rivera, CA 90660 City Of San Bernerdino 290 North S Street San Bernardino, CA 92401 City Of San Bernerdino 290 North S Street San Bernardino, CA 92401 Cosunes Community Services District 880 Elk Grove Blvd Grove, CA 95624 Cosunes Community Services District 880 Elk Grove Blvd Grove, CA 95624 City Of Fontana 8353 Sierra Ave Fontana, CA 92335 City Of Fontana 8353 Sierra Ave Fontana, CA 92335 City Of Menifee 29844 Haun Rd Menifee, CA 92586 City Of Menifee 29844 Haun Rd Menifee, CA 92586 DocuSign Envelope ID: FA4C9BA1-4FBB-4912-9A17-CE8450B206B9 UDC-5219378-EO-22 COUNTY OF ORANGE SHERIFF-CORONER DEPARTMENT 550 N FLOWER ST SANTA ANA CA 92703CITY OF PLACENTIA 401 E CHAPMAN AVE PLACENTIIA CA 92870CITY OF SAN CLEMENTE 910 CALLE NEGOCIO SAN CLEMENTE CA 92673 CITY OF STOCKTON 425 N EL DORADO ST STOCKTON CA 92503 CITY OF TUCSON 255 W ALAMEDA 6TH FLOOR TUCSON AZ 85701 CITY OF VACAVILLE 650 MERCHANT ST VACAVILLE CA 95688 CITY OF GARDEN GROVE 11222 ACACIA PKWY GARDEN GROVE CA 92840 CITY OF CORONA 400 S VICENTIA AVE SUITE 155 CORONA CA, 92882 City Of Monrovia 415 S Ivy Ave Monrovia, CA 91016 City Of Montebello 1600 W Beverly Blvd Montebello, CA 90640 City Of Pico Rivera 6615 Passons Blvd Pico Rivera, CA 90660 City Of San Bernerdino 290 North S Street San Bernardino, CA 92401 Cosunes Community Services District 880 Elk Grove Blvd Grove, CA 95624 City Of Fontana 8353 Sierra Ave Fontana, CA 92335 City Of Menifee 29844 Haun Rd Menifee, CA 92586 DocuSign Envelope ID: FA4C9BA1-4FBB-4912-9A17-CE8450B206B9 UDC-5219378-EO-22 DocuSign Envelope ID: FA4C9BA1-4FBB-4912-9A17-CE8450B206B9 UDC-5219378-EO-22 COUNTY OF ORANGE SHERIFF-CORONER DEPARTMENT 550 N FLOWER ST SANTA ANA CA 92703CITY OF PLACENTIA 401 E CHAPMAN AVE PLACENTIIA CA 92870 CITY OF SAN CLEMENTE 910 CALLE NEGOCIO SAN CLEMENTE CA 92673 CITY OF STOCKTON 425 N EL DORADO ST STOCKTON CA 92503 CITY OF TUCSON 255 W ALAMEDA 6TH FLOOR TUCSON AZ 85701 CITY OF VACAVILLE 650 MERCHANT ST VACAVILLE CA 95688 CITY OF GARDEN GROVE 11222 ACACIA PKWY GARDEN GROVE CA 92840 CITY OF CORONA 400 S VICENTIA AVE SUITE 155 CORONA CA, 92882 City Of Monrovia 415 S Ivy Ave Monrovia, CA 91016 City Of Montebello 1600 W Beverly Blvd Montebello, CA 90640 City Of Pico Rivera 6615 Passons Blvd Pico Rivera, CA 90660 City Of San Bernerdino 290 North S Street San Bernardino, CA 92401 Cosunes Community Services District 880 Elk Grove Blvd Grove, CA 95624 City Of Fontana 8353 Sierra Ave Fontana, CA 92335 City Of Menifee 29844 Haun Rd Menifee, CA 92586 DocuSign Envelope ID: FA4C9BA1-4FBB-4912-9A17-CE8450B206B9