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<br />CERTIFICATE OF LIABILITY INSURANCE
<br />DA8/10/2021
<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 endorsements .
<br />PRODUCER License #-OE67768
<br />CONTNA,EACT Gig! Yuen
<br />(uc0°,Nri ,Eat: (925) 660.3514 50008 (Aiic, No):(925) 416-7869
<br />IDA Insurance ServicesFAX
<br />3875 Hopyard Road -
<br />Suite 200
<br />AixmQAa1EBs. Gigi.Yuen@ioausa.com
<br />INSURER S AFFORDING COVERAGE
<br />NAIL N
<br />Pleasanton, CA 94588
<br />INSURER A: Travelers Property Casualty Company of America
<br />25674
<br />INSURED
<br />INSURER BArch Insurance Company
<br />11150
<br />INSURER C:
<br />JLee Engineering, Inc.
<br />INSURER D :
<br />430 S. Garfield Avenue, #301
<br />Alhambra, CA 91801
<br />INSURER E
<br />INSURER F
<br />COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
<br />THIS IS TO CERTIFY THAT ITHE 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 />TYPE OFINSURANCE
<br />ADDLSUBR
<br />POLICY NUMBER
<br />POLICY EFF
<br />POLICY EXP
<br />LIMITS
<br />A
<br />)(
<br />COMMERCIAL GENERAL LIABILITY
<br />EACH OCCURRENCE
<br />2,000,000
<br />CLAIMS-MADEOCCUR
<br />LAIPREMISES
<br />6802HO13864
<br />9/112021
<br />911/2022
<br />DAMAGE TO RENTED
<br />(Ea occurrence)
<br />$ 1,000,000
<br />MED EXP (Anyone erson
<br />10,000
<br />PERSONAL B ADV INJURY
<br />S 2,000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />POLICY [XI ypef 71 LOG
<br />GENERALAGGREGATE
<br />4,000,000
<br />PRODUCTS - COMP/OP AGG
<br />4,000,000
<br />OTHER:
<br />A
<br />LIABILITY
<br />CEOMBINEED SINGLE LIMIT
<br />$ 2,000,000
<br />BODILY INJURY Per person)$
<br />ANYAUTO
<br />6802HO13864
<br />9/112021
<br />911/2022
<br />BODILY INJURY Perawident
<br />$
<br />POMOBILE
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />PerOa EaiRtlen DAMAGE
<br />WW��
<br />AUTOS ONLY X AUTOSONLV
<br />UMBRELLA LIAR
<br />OCCUR
<br />EACH OCCURRENCE
<br />$
<br />AGGREGATE
<br />EXCESS LIAR
<br />CLAIMS -MADE
<br />DIED I I RETENTIONS
<br />A
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY YIN
<br />ANY PROPRIETORIPARTNEWEXECUTIVE ❑
<br />ooFFICERIMEMBER EXCLUDED?
<br />(Mandatory in NH)
<br />NIA
<br />-,
<br />UB3J84391A -
<br />-
<br />9/112021
<br />911/2022
<br />)t I SERTUTE I OTH-
<br />ER
<br />E.L. EACH ACCIDENT
<br />1,000,000
<br />E.L DISEASE - EA EMPLOYE
<br />1,000,000
<br />$
<br />E.L. DISEASE -POLICY LIMIT
<br />11000,000
<br />It yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />B
<br />Professional Liab.
<br />PAAEP00102503
<br />9/112021
<br />9/112022
<br />Per Claim
<br />1,000,000
<br />B
<br />Professional Liab.
<br />PAAEP00102503
<br />91112021
<br />91112022
<br />Aggregate
<br />2,000,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached Nmore space is required)
<br />All Operations of the Named Insured.
<br />General Liability: See Additional Insured Endorsement attached; such coverage is Primary & Non -Contributory and includes Separation of Insureds, as
<br />required per written contract.
<br />NOTE: No company -owned vehicles. General Llablity includes coverage for Hired & Non -Owned Auto Liability.
<br />GENERAL LIABILITY ADDITIONAL INSURED INCLUDES THE FOLLOWING PERSON(S) OR ORGANIZATION(S): City of Santa Ana, its officers, employees, and
<br />authorized agents
<br />CANCELLATION NOTICE: 30 days written notice is provided to the aforementioned Certificate Holder.
<br />City of Santa Ana
<br />Risk Management Division
<br />20 Civic Center Plaza, 4th Floor
<br />ACORD 25 (2016/03)
<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 REPRESENTATIVE
<br />on
<br />/ t— 1— y ,5 1Ewm&agmuntDD Sy.,
<br />RbVlblVm6APPROVm BY:
<br />©1988-2015 ACORD C
<br />Risk Management Analyst
<br />The ACORD name and logo are registered marks of ACORD
<br />
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