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<br />MBREYEL-01NGARCIA
<br />DATE (MM/DD/YYYY)
<br />CERTIFICATE OF LIABILITY INSURANCE
<br />2/10/2026
<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 />CONTACT
<br />Noemi Garcia
<br />PRODUCER
<br />NAME:
<br />PHONEFAX
<br />Orion Business Insurance and Risk Management Services, Inc.
<br />(626) 773-8488(951) 737-5083
<br />(A/C, No, Ext):(A/C, No):
<br />1250 Corona Pointe Court, Suite 302
<br />E-MAIL
<br />ngarcia@orionins.com
<br />Corona, CA 92879
<br />ADDRESS:
<br />INSURER(S) AFFORDING COVERAGENAIC #
<br />Canopius US Insurance Inc.12961
<br />INSURER A :
<br />INSURED
<br />National Fire & Marine Insurance Company20079
<br />INSURER B :
<br />Insurance Company of the West27847
<br />INSURER C :
<br />M. Brey, Inc. dba MBE Construction
<br />P O Box 3159
<br />Fortegra Specialty Insurance Company16823
<br />INSURER D :
<br />Beaumont, CA 92223
<br />INSURER E :
<br />INSURER F :
<br />2
<br />COVERAGESCERTIFICATE NUMBER: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 />INSRADDLSUBRPOLICY EFFPOLICY EXP
<br />TYPE OF INSURANCEPOLICY NUMBERLIMITS
<br />LTRINSDWVD(MM/DD/YYYY)(MM/DD/YYYY)
<br />1,000,000
<br />A
<br />COMMERCIAL GENERAL LIABILITY
<br />X
<br />EACH OCCURRENCE$
<br />DAMAGE TO RENTED
<br />100,000
<br />CLAIMS-MADEOCCUR
<br />X
<br />CUSPC19000173-0111/13/202511/13/2026
<br />$
<br />PREMISES (Ea occurrence)
<br />XX
<br />MED EXP (Any one person)$
<br />1,000,000
<br />PERSONAL & ADV INJURY$
<br />2,000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER:GENERAL AGGREGATE$
<br />PRO-
<br />2,000,000
<br />X
<br />POLICYLOC
<br />PRODUCTS - COMP/OP AGG$
<br />JECT
<br />OTHER:$
<br />COMBINED SINGLE LIMIT
<br />1,000,000
<br />B
<br />AUTOMOBILE LIABILITY
<br />$
<br />(Ea accident)
<br />ANY AUTO 72APB01291311/13/202511/13/2026
<br />BODILY INJURY (Per person)$
<br />XX
<br />OWNEDSCHEDULED
<br />X
<br />AUTOS ONLYAUTOSBODILY INJURY (Per accident)$
<br />PROPERTY DAMAGE
<br />HIREDNON-OWNED
<br />(Per accident)$
<br />AUTOS ONLYAUTOS ONLY
<br />$
<br />5,000,000
<br />A
<br />X
<br />UMBRELLA LIABOCCUR
<br />EACH OCCURRENCE$
<br />CUSXS20000077-0111/13/202511/13/2026
<br />5,000,000
<br />EXCESS LIABCLAIMS-MADE
<br />X
<br />AGGREGATE$
<br />DEDRETENTION$
<br />$
<br />PEROTH-
<br />WORKERS COMPENSATION
<br />C
<br />X
<br />STATUTEER
<br />AND EMPLOYERS' LIABILITY
<br />Y / N
<br />WSD 5088419 002/12/20262/12/2027
<br />1,000,000
<br />X
<br />ANY PROPRIETOR/PARTNER/EXECUTIVE
<br />E.L. EACH ACCIDENT$
<br />N / A
<br />OFFICER/MEMBER EXCLUDED?
<br />1,000,000
<br />(Mandatory in NH)
<br />E.L. DISEASE - EA EMPLOYEE$
<br />If yes, describe under
<br />1,000,000
<br />DESCRIPTION OF OPERATIONS belowE.L. DISEASE - POLICY LIMIT$
<br />Errors & OmissionsAXC1000402-0110/9/202511/13/2026
<br />Each Claim1,000,000
<br />D
<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.
<br />CzUvUsboOhvzfobu21;38bn-Gfc22-3137
<br />CERTIFICATE HOLDERCANCELLATION
<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
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />Attn: Franklin Fallon
<br />220 S. Daisy Ave
<br />AUTHORIZED REPRESENTATIVE
<br />Santa Ana, CA 92701
<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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