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DATE(MM/DD/YYYY)
<br /> AC" CERTIFICATE OF LIABILITY INSURANCE
<br /> 11/06/2024
<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 CONTACT David Saechao-RM
<br /> NAME:
<br /> The Liberty Company Insurance Brokers AICNNo Ext: (888)918-3960 ac,No
<br /> Lic#OD79653 E-MAIL David.Saechao@libertycompany.com
<br /> ADDRESS:
<br /> 5955 De Soto Ave,Ste 250 INSURER(S)AFFORDING COVERAGE NAIC#
<br /> Woodland Hills CA 91367 INSURERA: Continental Casualty Company 20443
<br /> INSURED INSURER B: Valley Forge Ins Co 20508
<br /> TRB AND ASSOCIATES INSURER C: Transportation Insurance Co 20494
<br /> 3180 CROW CANYON PL#216 INSURER D: Employers Preferred Ins.Co. 10346
<br /> INSURER E: U.S.Specialty Insurance Co. 29599
<br /> SAN RAMON CA 94583 INSURER F:
<br /> COVERAGES CERTIFICATE NUMBER: CL2411541740 REVISION NUMBER:
<br /> THIS IS TO CERTIFYTHAT 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
<br /> CERTIFICATE MAYBE 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 UBR POLICY NUMBER MM/DD YYYYMPOLICY EFF O DD YYYY LIMITS
<br /> ICY EXP
<br /> LTR INSD WVD
<br /> X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000
<br /> DAMAGE_7CLAIMS-MADE �OCCUR PREM SESOEa occu«Dence $ 1,000,000
<br /> MED EXP(Any one person) $ 10,000
<br /> A Y 2097186534 11/10/2024 11/10/2025 PERSONAL&ADV INJURY $ 2,000,000
<br /> GEN'LAGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $ 4,000,000
<br /> X POLICY ❑ PRO ❑ 4,000,000
<br /> JECT LOC PRODUCTS-COMP/OPAGG $
<br /> X OTHER: Cyber liability occur/aggregate $ 1,000,000
<br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000
<br /> Ea accident
<br /> ANYAUTO BODILY INJURY(Per person) $
<br /> B X OWNED SCHEDULED Y 7013446068 11/10/2024 11/10/2025 BODILY INJURY(Per accident) $
<br /> /� AUTOS ONLY AUTOS
<br /> X HIRED �/ NON-OWNED PROPERTY DAMAGE $
<br /> AUTOS ONLY /� AUTOS ONLY (per.
<br /> Per accident
<br /> Medical payments $ 5,000
<br /> X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 2,000,000
<br /> C EXCESSLIAB CLAIMS-MADE 7036238862 11/10/2024 11/10/2025 AGGREGATE $ 2,000,000
<br /> DED I X1 RETENTION$ $
<br /> WORKERS COMPENSATION X STATUTE ER
<br /> AND EMPLOYERS'LIABILITY Y/N 1,000,000
<br /> ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $
<br /> D OFFICER/MEMBER EXCLUDED? F NIA Y EIG463819504 11/10/2024 11/10/2025
<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 /> profesisonal liability per occ 2,000,000
<br /> E USS2435165 11/10/2024 11/10/2025 aggregate 2,000,000
<br /> retention 25,000
<br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
<br /> Whereby required by written contract or agreement,City of Santa Ana,its officers,employees,agents and representatives are included as additional insured
<br /> with respect to general liability and auto liability.Insurance is primary and non-contributory.Waiver of subrogation applies to workers compensation.
<br /> APPROVED
<br /> By Cynthia Mora at 5:30 pm, Dec 02, 2024
<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 PROVISIONS.
<br /> Risk Manangement Division
<br /> AUTHORIZED REPRESENTATIVE
<br /> 20 Civic Center Plaza,4th FI n
<br /> Santa Ana CA 92701
<br /> ©1988-2015 ACORD CORPORATION. All rights reserved.
<br /> ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD
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