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<br />Tori Pierson Date: 2102205.181318:07 Da0T00'
<br />AC"RbP CERTIFICATE OF LIABILITY INSURANCE
<br />DATE(MMIDDNYYY)
<br />5/1012022
<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($).
<br />PRODUCER
<br />Alliant Insurance Services, Inc.
<br />18100 Von Karmen, 1Oth Floor
<br />Irvine CA 92612
<br />C NTACT
<br />NAME: Yvonne Chong
<br />PHONE 949.66D.5967 FAX
<br />C No:
<br />ADDRESS; ychong@alllant.com
<br />INSURERS AFFORDING COVERAGE
<br />NAICW
<br />INSURERA: Federal Insurance Company
<br />20281
<br />INSURED
<br />Macro-Z-Technology Company
<br />841 E Washington Ave.
<br />INSURER B: Executive Risk Indemnity Inc
<br />35181
<br />INsuRERc: Allied World National Assuranc
<br />10690
<br />INSURER D: Indian Harbor Insurance Com an
<br />36940
<br />Santa Ana CA 92701
<br />INSURER E: Starr Indemnity & Liability Co
<br />38318
<br />INSURER F :
<br />COVERAGES CERTIFICATE NUMBER: 1352408476 RFVI-SIGN MHMRFR-
<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 />INTR
<br />TYPE OF INSURANCE
<br />ADDLSUBR
<br />POLICY NUMBER
<br />POLICY EFF
<br />MM/UD
<br />POLICY E%P
<br />DIYYYY
<br />LIMITS
<br />B
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE
<br />54309459-03
<br />10/1/2021
<br />10/1/2022
<br />EACH OCCURRENCE
<br />$1.000,000
<br />DAMAGE( aoc D
<br />PREMISESSKtNI Irrence)
<br />$100,000
<br />MED EXP(Any oneperson)
<br />$5,000
<br />PERSONAL&ADV INJURY
<br />$1, 000,000
<br />AGGREGATE LIMIT APPLIES PER:
<br />POLICY [X]jECT F—]LOC
<br />GENERAL AGGREGATE
<br />$2,000,000
<br />GENT
<br />PRODUCTS - COMP/OP AGG
<br />$2,000,000
<br />Deductible
<br />$5,000
<br />OTHER:
<br />I
<br />A
<br />AUTOMOBILE
<br />LIABILITY
<br />54309639
<br />10/1/2021
<br />10/1/2022
<br />COMBINED SINGLE LIMIT
<br />eccldent
<br />$1,000,000Ee
<br />X
<br />ANY AUTO
<br />BODILY INJURY (Per person)
<br />$
<br />X
<br />OWNED
<br />AUTOS ONLYNAUTOSULED
<br />BODILY INJURY (PeraccldenQ
<br />$
<br />X
<br />HIRED NN-OWNED
<br />AUTOS ONLYAUTOS ONLY
<br />PROPERTYDAMAGE
<br />Per eccldent
<br />$
<br />Deductible
<br />$1,000
<br />E
<br />X
<br />UMBRELLALIAB
<br />EXCESS LIAR
<br />X
<br />OCCUR
<br />CLAIMS -MADE
<br />03115450-03
<br />1000586615211.03
<br />1DII/2021
<br />1D/l/2021
<br />10/1/2022
<br />10/1/2022
<br />EACH OCCURRENCE
<br />$18,000,000
<br />AGGREGATE
<br />$18,OD0,000
<br />DEO I X I RETENTION
<br />$
<br />A
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY YIN
<br />ANYPROPRIETOR/PARTNEWEXECUTIVE
<br />OFFICERIMEMBEREXOLUDED2
<br />NIA
<br />64309538
<br />101U2021
<br />10/1/2022
<br />X STATUTE ERH
<br />E.L. EACH ACCIDENT
<br />$1,000,000
<br />E.L. DISEASE - EA EMPLOYEE
<br />$1,000,000
<br />(Mandatory in NH)
<br />If yes, describe under
<br />E.L. DISEASE -POLICY LIMIT
<br />$1,000,000
<br />DESCRIPTION OF OPERATIONS below
<br />D
<br />ProfessionaVPollution
<br />pEC000663221
<br />10/1 /2021
<br />10/1/2022
<br />Each Clelm
<br />$5,000,000
<br />Aggregate
<br />SIR
<br />$5,DDD,ODO
<br />$26,000
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space Is required)
<br />Re: Provide On -Call Demolition Services for the City Of Santa Ana.
<br />City of Santa Ana, officers, agents, employees, and volunteers are named as additionally insured as respects General and Auto Liability pursuant to written
<br />contract, agreement, or memorandum of understanding. Such Insurance as is afforded by this policy shall be primary, and any insurance carried by City shall
<br />be excess and noncontributory. Waiver of subrogation applies to Workers' Compensation. 30 Days Notice of Cancellation with 10 Days Notice for
<br />Non -Payment of Premium in accordance with the policy provisions.
<br />City of Santa Ana
<br />Risk Management Division
<br />20 Civic Center Plaza
<br />Santa Ana CA 92702
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />AUTHORIZED REPyRR�EESENTATIVE
<br />4
<br />V 1Uoe-ZUIOAUUKUUt "-"'"a""'^"""^'
<br />ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD
<br />
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