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MBREYEL-01
<br />NGARCIA
<br />,d►coRO CERTIFICATE OF LIABILITY INSURANCE
<br />DATE 11/17/20YYYY)
<br />1 /17/25
<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 />CONTACT Noemi Garcia
<br />NAME:
<br />PHONE FAX
<br />(A/C, No, Ext): (626) 773-8488 No):(951) 737-5083
<br />Orion Business Insurance and Risk Management Services, Inc.
<br />1250 Corona Pointe Court, Suite 302
<br />Corona, CA 92879
<br />E-MAIL-ADDRESS: ngarcia@orionins.com
<br />INSURERS AFFORDING COVERAGE
<br />NAIC #
<br />INSURERA:CanO ius US Insurance Inc.
<br />12961
<br />INSURED
<br />INSURERB: National Fire & Marine Insurance Company
<br />20079
<br />INSURERC: Everest Premier Insurance Company
<br />16045
<br />M. Brey, Inc., dba MBE Construction
<br />INSURERD: Forte ra Specialty Insurance Company
<br />16823
<br />P O Box 3159
<br />Beaumont, CA 92223
<br />INSURER E
<br />INSURER F :
<br />COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: 2
<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/YYYY
<br />POLICY EXP
<br />MM/DD/YYYY
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />CLAIMS -MADE X OCCUR
<br />X
<br />X
<br />CUSPC19000173-01
<br />11/13/2025
<br />11/13/2026
<br />DAMAGE TO RENTED
<br />PREMISES Ea occurrence
<br />100,000
<br />$
<br />MED EXP (Any oneperson)
<br />$
<br />PERSONAL & ADV INJURY
<br />$ 1,000,000
<br />GENT
<br />AGGREGATE LIMIT APPLIES PER:
<br />GENERAL AGGREGATE
<br />$ 2,000,000
<br />POLICY X 71 PEA LOC
<br />PRODUCTS - COMP/OP AGG
<br />$ 2,000,000
<br />$
<br />OTHER:
<br />B
<br />AUTOMOBILE
<br />LIABILITY
<br />COMBINED SINGLE LIMIT
<br />Ea accident
<br />1,000,000
<br />$
<br />BODILY INJURY Perperson)
<br />$
<br />ANY AUTO
<br />X
<br />X
<br />72APBO12913
<br />11/13/2025
<br />11/13/2026
<br />OWNED SCHEDULED
<br />AUTOS ONLY X AUTOS
<br />BODILY INJURY Per accident
<br />$
<br />PROPERTY DAMAGE
<br />Per accident)
<br />ccident
<br />$
<br />HIRED NON -OWNED
<br />AUTOS ONLY AUTOS ONLY
<br />A
<br />UMBRELLA LIAB
<br />X
<br />OCCUR
<br />EACH OCCURRENCE
<br />$ 5,000,000
<br />X
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />CUSXS20000077-01
<br />11/13/2025
<br />11/13/2026
<br />AGGREGATE
<br />$ 5,000,000
<br />DED RETENTION $
<br />$
<br />C
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY
<br />ANY PROPRIETOR/ R/EXECUTIVE
<br />X
<br />7600026637251
<br />2/12/2025
<br />2/12/2026
<br />X PER OTH-
<br />STATUTE ER
<br />E.L. EACH ACCIDENT
<br />1,000,000
<br />$
<br />OFFICER/MEMBER EXCLUDED?
<br />EXCLU ❑
<br />(Mandatory in NH)
<br />A
<br />N/A
<br />E.L. DISEASE - EA EMPLOYEE
<br />$ 1,000,000
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE - POLICY LIMIT
<br />1,000,000
<br />$
<br />D
<br />Errors & Omissions
<br />AXC1000402-01
<br />10/9/2025
<br />11/13/2026
<br />[Each Claim
<br />1,000,000
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
<br />Re: Extension of Agreement (A-2022-025-03) for On Call Electrical Repair and Rehabilitation Services
<br />City of Santa Ana, its City Council, officers, officials, employees, agents, and volunteers are listed as additional insured(s) as respects General Liability and
<br />Auto Liability per the attached policy forms. Primary wording is included as respects General Liability per the attached policy form. Waiver of subrogation is
<br />included as respects General Liability, Auto Liability, and Workers' Compensation per the attached policy forms. Notice of cancellation will be delivered in
<br />accordance with the policy provisions. Digitally signed by
<br />Tu Tran Tu Tran Nguyen
<br />Date: 2025.11.17
<br />Nguyen 1161324-08.00. APPROVED
<br />By Tu Tran Nguyen at 4:12 pm, Nov 17, 2025
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />City of Santa Ana THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />Y ACCORDANCE WITH THE POLICY PROVISIONS.
<br />Attn: Franklin Fallon
<br />220 S. Daisy Ave
<br />Santa Ana, CA 92701 AUTHORIZED REPRESENTATIVE
<br />ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved.
<br />The ACORD name and logo are registered marks of ACORD
<br />
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