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ACCORD® CERTIFICATE OF LIABILITY INSURANCE
<br />DATE(MM/DDmYY)
<br />7/1/2024
<br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
<br />CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
<br />BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
<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 />IOA Insurance Service
<br />130 Vantis '
<br />AE-MAIL
<br />Suite 250
<br />CONTACT „
<br />NAME: one
<br />PHONE
<br />A/C No E. t':
<br />-
<br />F
<br />C,
<br />o -MWd IC
<br />ADDRESS: Ch I.Perkovich
<br />i ausa.com
<br />(
<br />NG COVERAGE
<br />NAIC #
<br />Allso Viejo CA 92656
<br />A: Ti
<br />Iers Prope I C n f e 'c
<br />2 7INSURED
<br />License#: OE67768rINSUREF
<br />DUTHELE-01r
<br />Electric Service p!:CIO
<br />2335 E. Cherry Indust e V
<br />R B: C
<br />'��r n .
<br />4Duthie
<br />&RC: Houston sual Compan
<br />42374
<br />W URER D : The T el(I (46mnity Company of Connecticut
<br />INSURER E: Travelers Property Casualty Insurance Company
<br />25682
<br />36161
<br />Long Beach CA 9080
<br />INSURER F : At -Bay Specialty Insurance Company
<br />19607
<br />COVERAGES CERTIFICATE NUMBER:655371844 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 />POLICYNUMBER
<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 />Y-630-2A626927-TIL-24
<br />7/1/2024
<br />7/1/2025
<br />EACH OCCURRENCE
<br />$1,000,000
<br />CLAIMS -MADE � OCCUR
<br />RENTED
<br />DA AGE ToEa occurrence
<br />PREM SES
<br />$ 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 />$2,000,000
<br />POLICY � jRa1:1 LOC
<br />PRODUCTS - COMP/OP AGG
<br />$ 2,000,000
<br />Deductible
<br />$ 0
<br />OTHER:
<br />D
<br />AUTOMOBILE
<br />LIABILITY
<br />Y
<br />Y
<br />810-2N338740-24-14-G
<br />7/1/2024
<br />7/1/2025
<br />COMBINED SINGLE LIMIT
<br />Ea accident
<br />$1,000,000
<br />X
<br />BODILY INJURY (Per person)
<br />$
<br />ANYAUTO
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />BODILY INJURY (Per accident)
<br />$
<br />X
<br />PROPERTYDAMAGE
<br />Per accident
<br />$
<br />HIRED NON -OWNED
<br />AUTOS ONLY AUTOS ONLY
<br />E
<br />X
<br />UMBRELLALIAB
<br />X
<br />OCCUR
<br />Y
<br />Y
<br />CUP-3S17641A-24-NF
<br />7/1/2024
<br />7/1/2025
<br />EACH OCCURRENCE
<br />$15,000,000
<br />AGGREGATE
<br />$ 15,000,000
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />DED X RETENTION $ in nnn
<br />$
<br />A
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY Y / N
<br />ANYPROPRIETOR/PARTNER/EXECUTIVE
<br />Y
<br />UB-7K475503-24-14-G
<br />7/1/2024
<br />7/1/2025
<br />X PER OTH-
<br />STATUTE ER
<br />E.L. EACH ACCIDENT
<br />$ 1,000,000
<br />OFFICER/MEMBEREXCLUDED. ❑
<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 />PKC115513
<br />7/1/2024
<br />7/1/2025
<br />Occurence/Aggregate
<br />$3,000,000
<br />C
<br />F
<br />Contractors Professional
<br />Cyber Liability
<br />HCC2471053
<br />AB-6608105-04
<br />7/1/2024
<br />7/1/2024
<br />7/1/2025
<br />7/1/2025
<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, may be attached if more space is required)
<br />"Contractors Pollution - $10,000 Deductible
<br />"Contractors Professional (Claims Made) - $10,000 Each Claim Deductible
<br />The certificate holder(s) is/are included as an additional insured(s) with respects to General Liability for Ongoing and Completed Operations and Auto Liability
<br />(per forms CG D6 04 02 19, CG D4 58 02 19 and CA T3 53 02 15); General Liability and Auto Liability are Primary and Non -Contributory (per forms CG T1 00
<br />02 19 and CA 00 01 10 13); Waiver of Subrogation applies to General Liability, Auto Liability and Workers Compensation (per forms CG D4 58 02 19, CA T3 53
<br />02 15 and WC 99 03 76); Additional Insured and Waiver of Subrogation applies to Umbrella Liability; Umbrella Liability follows form. Per Project Aggregate
<br />Endorsement policy form CG D3 21 01 04 is provided as required by a written contract; All coverage is only applicable as required by written contract.
<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 PR
<br />Risk Management Division
<br />20 Civic Center Plaza, 4th floor AUTHORIZED REPRESENTATIVE
<br />Santa Ana CA 92701 r
<br />©1988-2015 ACORD
<br />ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD
<br />oR.N a Risk MougmumtDMs(an
<br />f ° REVIEWED & MPROVm BY:
<br />° WAfg Aezv
<br />_1" Risk Management Specialist
<br />
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