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MBREYEL-01 NGARCIA
<br /> ,d►coRo CERTIFICATE OF LIABILITY INSURANCE FD 1 1/17/20YYYY)
<br /> /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 CONTACT Noemi Garcia
<br /> NAME:
<br /> Orion Business Insurance and Risk Management Services,Inc. PHONE FAX
<br /> 1250 Corona Pointe Court,Suite 302 (A/C,No,Ext):(626)773-8488 No):(951)737-5083
<br /> Corona,CA 92879 E-MAIL-ADDRESS:ngarcia@orionins.com
<br /> INSURERS AFFORDING COVERAGE NAIC#
<br /> INSURERA:CanO ius US Insurance Inc. 12961
<br /> INSURED INSURERB:National Fire&Marine Insurance Company 20079
<br /> M.Brey,Inc.,dba MBE Construction INSURERC:Everest Premier Insurance Company 16045
<br /> P O Box 3159 INSURERD:Forte ra Specialty Insurance Company 16823
<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 TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS
<br /> LTR INSD WVD MM/DD/YYYY MM/DD/YYYY
<br /> A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
<br /> CLAIMS-MADE X OCCUR CUSPC19000173-01 11/13/2025 11/13/2026 DAMAGE TO RENTED 100,000
<br /> X X PREMISES Ea occurrence $
<br /> MED EXP(Any oneperson) $
<br /> PERSONAL&ADV INJURY $ 1,000,000
<br /> GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000
<br /> POLICY X 71 PEA LOC PRODUCTS-COMP/OP AGG $ 2,000,000
<br /> OTHER: $
<br /> B AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000
<br /> Ea accident $
<br /> ANY AUTO X X 72APBO12913 11/13/2025 11/13/2026 BODILY INJURY Perperson) $
<br /> OWNED SCHEDULED
<br /> AUTOS ONLY X AUTOS BODILY INJURY Per accident $
<br /> HIRED NON-OWNED PROPERTY DAMAGE
<br /> AUTOS ONLY AUTOS ONLY Per accident)
<br /> ccident $
<br /> A UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000
<br /> X EXCESS LIAB CLAIMS-MADE CUSXS20000077-01 11/13/2025 11/13/2026 AGGREGATE $ 5,000,000
<br /> DED RETENTION$ $
<br /> C WORKERS COMPENSATION X PER OTH-
<br /> AND EMPLOYERS'LIABILITY STATUTE ER
<br /> 7600026637251 2/12/2025 2/12/2026 1,000,000
<br /> ANY PROPRIETOR/ R/EXECUTIVE ❑ X E.L.EACH ACCIDENT $
<br /> EXCLU
<br /> OFFICER/MEMBER EXCLUDED? N/A
<br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000
<br /> If yes,describe under 1,000,000
<br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $
<br /> D Errors&Omissions AXC1000402-01 10/9/2025 11/13/2026 [Each Claim 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 /> ate:2025.1
<br /> Nguyen D61324-08'00'7 APPROVED
<br /> CERTIFICATE HOLDER CANCELLATION 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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