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Digitally siqned by
<br />ACCOROF CERTIFICATE OF LIABILIMAgWNCE Angie
<br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND jNF�E,,RS NO RIGHTS 9JPON t'HED IC�@)0)70 IH,s
<br />CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTE��IM GE AFFORDED BY THE POLICIES
<br />BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A O gq�1�.B SSUIN�IV�lJ�Z G7f IWIZED
<br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
<br />IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed.
<br />If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on
<br />this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
<br />PRODUCER
<br />CONTACT
<br />NAME: Elizabeth Leach
<br />IOA Insurance Services
<br />130 Vantis
<br />PHONE FAX
<br />,vc No Ext :949-297-5962 A/C, No): 949-297-5960
<br />ADDE-MRESS: elizabeth.leach@ioausa.com
<br />Suite 250
<br />INSURER(S) AFFORDING COVERAGE
<br />NAIC#
<br />Aliso Viejo CA 92656
<br />INSURERA: Travelers Property Casualty Company of America
<br />25674
<br />License#: OE67768
<br />INSURED DUTHELE-01
<br />INSURERB: Crum & Forster Specialty Insurance Company
<br />44520
<br />Duthie Electric Service Corp dba: Duthie Power Services
<br />2335 E. Cherry Industrial Circle
<br />INSURERC: Houston Casualty Company
<br />42374
<br />INSURERD: HSB Specialty Insurance Company
<br />14438
<br />Long Beach CA 90805
<br />INSURER E
<br />INSURER F
<br />COVERAGES CERTIFICATE NUMBER: 1863587873 REVISION NUMBER:
<br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
<br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />INSR
<br />LTR
<br />TYPE OF INSURANCE
<br />ADDL
<br />INSD
<br />SUBR
<br />WVD
<br />POLICY NUMBER
<br />POLICY EFF
<br />MM/DD
<br />POLICY EXP
<br />MM/DD
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />Y
<br />Y
<br />Y6302A626927
<br />7/1/2022
<br />7/1/2023
<br />EACH OCCURRENCE
<br />$1,000,000
<br />CLAIMS -MADE OCCUR
<br />DAMAGE TO RENTED
<br />PREMISES Ea occurrence
<br />$ 300,000
<br />MED EXP (Any one person)
<br />$ 5,000
<br />PERSONAL &ADV INJURY
<br />$ 1,000,000
<br />GEN'L
<br />AGGREGATE LIMIT APPLIES PER:
<br />GENERAL AGGREGATE
<br />$ 2,000,000
<br />POLICY � PE� LOC
<br />PRODUCTS - COMP/OP AGG
<br />$ 2,000,000
<br />Deductible
<br />$ 0
<br />OTHER:
<br />A
<br />AUTOMOBILE
<br />LIABILITY
<br />Y
<br />Y
<br />8102N3387402114G
<br />7/1/2022
<br />7/1/2023
<br />COMBINED SINGLE LIMIT
<br />Ea accident
<br />$1,000,000
<br />X
<br />BODILY INJURY (Per person)
<br />$
<br />ANY AUTO
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />BODILY INJURY (Per accident)
<br />$
<br />X
<br />PROPERTY DAMAGE
<br />Per accident
<br />$
<br />HIRED X NON -OWNED
<br />AUTOS ONLY AUTOS ONLY
<br />A
<br />X
<br />UMBRELLALIAB
<br />X
<br />OCCUR
<br />Y
<br />Y
<br />CUP3S17641A22NF
<br />7/1/2022
<br />7/1/2023
<br />EACH OCCURRENCE
<br />$15,000,000
<br />AGGREGATE
<br />$ 15,000,000
<br />EXCESS LAB
<br />CLAIMS -MADE
<br />DED X RETENTION $ 1 n nnn
<br />$
<br />A
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY Y / N
<br />ANYPROPRIETOR/PARTNER/EXECUTIVE
<br />Y
<br />UB7K4755032114G
<br />7/1/2022
<br />7/1/2023
<br />X PER OTH-
<br />STATUTE ER
<br />E.L. EACH ACCIDENT
<br />$ 1,000,000
<br />OFFICE R/M EMBER EXCLUDED? ❑
<br />N/A
<br />E.L. DISEASE - EA EMPLOYEE
<br />$ 1,000,000
<br />(Mandatory in NH)
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE - POLICY LIMIT
<br />$ 1,000,000
<br />B
<br />Contractors Pollution
<br />PKC111856
<br />7/1/2022
<br />7/1/2023
<br />Occurence/Aggregate
<br />$3,000,000
<br />C
<br />D
<br />Contractors Professional
<br />Cyber
<br />HCC2168107
<br />660810502
<br />7/1/2022
<br />3/15/2022
<br />7/1/2023
<br />3/15/2023
<br />Each Claim/Aggregate
<br />Each Claim/Aggregate
<br />$1,000,000
<br />$2,000,000
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required)
<br />The certificate holder(s) is/are included as an additional insured(s) with respects to General Liability for On -going and Completed Operations as per policy form
<br />CG D6 04 02 19 and Auto Liability as per policy form CA T3 53 02 15; General Liability and Auto Liability are Primary and Non -Contributory as per policy forms
<br />CG T1 00 02 19 and CA 00 01 10 13; Waiver of Subrogation applies to General Liability as per policy form CG D4 58 02 19, Auto Liability as per policy form CA
<br />T3 53 02 15 and Workers Compensation as per policy form WC 99 03 76; Additional Insured and Waiver of Subrogation applies to Umbrella Liability only as
<br />required by written contract; Umbrella Liability follows form. Per Project Aggregate Endorsement policy form CG D3 21 01 04 is provided as required by a
<br />written contract; All coverage is only applicable as required by written contract.
<br />Contractors Pollution
<br />See Attached...
<br />CERTIFICATE HOLDER CANCELLATION
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />City of Santa Ana ACCORDANCE WITH THE POLICY PROVISIONS.
<br />Risk Management Division
<br />20
<br />Santa Ana t 92701
<br />Civic Center Plaza, floor AUTHORIZED REPRESENTATIVE
<br />Risk kluagment DlMsian
<br />REVIEWED & APPROVED BY:
<br />@ 1988-2015 ACORD °(
<br />ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD Risk Management specialist
<br />
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