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<br /> aC40 05/13/2025 1 " CERTIFICATE OF LIABILITY INSURANCE DATE(M /2025
<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 Willis Towers Watson Certificate Center
<br /> NAME:
<br /> Willis Towers Watson Northeast, Inc.
<br /> c/o 26 Century Blvd PHONE 1-877-945-7378 F' 1-888-467-2378
<br /> A/C No Ext: A/C,No:
<br /> E-MAIL P.O. Box 305191 ADDRESS: certificates@willis.com
<br /> Nashville, TN 372305191 USA INSURER(S)AFFORDING COVERAGE NAIC#
<br /> INSURERA: XL Insurance America Inc 24554
<br /> INSURED INSURERB: Travelers Property Casualty Company of Ame 25674
<br /> Fieldturf USA Inc
<br /> c/o Sports Division INSURERC: Travelers Indemnity Company of America 25666
<br /> Tarkett Inc. INSURERD: Standard Fire Insurance Company 19070
<br /> 7445 Cote-de-Liesse Road, Suite 200 INSURER E: Berkley Assurance Company 39462
<br /> Montreal, QC H4T 1G2 CAN
<br /> INSURER F:
<br /> COVERAGES CERTIFICATE NUMBER: W39003489 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 /> INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS
<br /> LTR INSD WVD POLICYNUMBER MM/DD MM/DD
<br /> X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
<br /> � OCCUR DAMAGERENTED
<br /> CLAIMS-MADE
<br /> PREMISESl(Ea occurrence) $ 500,000
<br /> A MED EXP(Any one person) $ 10,000
<br /> y y US00010327LI25A 05/01/2025 05/01/2026 PERSONAL&ADV INJURY $ 1,000,000
<br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE $ 2,000,000
<br /> POLICY� PRO JECT ❑ LOC PRODUCTS-COMP/OPAGG $ 2,000,000
<br /> OTHER: $
<br /> AUTOMOBILE LIABILITY COMBINEDSINGLELIMIT $ 5,000,000
<br /> Ea accident
<br /> X ANY AUTO BODILY INJURY(Per person) $
<br /> B OWNED SCHEDULED y TC2JCAP-823K312A-TIL-25 05/01/2025 05/01/2026 BODILY INJURY(Per accident) $
<br /> AUTOS ONLY AUTOS
<br /> HIRED NON-OWNED PROPERTY DAMAGE $
<br /> AUTOS ONLY AUTOS ONLY Per accident
<br /> UMBRELLA LAB OCCUR EACH OCCURRENCE $
<br /> EXCESS LAB CLAIMS-MADE AGGREGATE $
<br /> DED RETENTION$ $
<br /> WORKERS COMPENSATION X PER OTH-
<br /> AND EMPLOYERS'LIABILITY Y/N STATUTE ER
<br /> C ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000
<br /> OFFICER/MEMBEREXCLUDED? No N/A y UB-8P793534-25-51-K 05/01/2025 05/01/2026 1,000,000
<br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $
<br /> If yes,describe under 1,000,000
<br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $
<br /> D Workers Compensation & y UB-8P760619-25-51-R 05/01/2025 05/01/2026 E.L. Each Accident $1,000,000
<br /> Employer's Liability E.L. Disease-Pol Lmt $1,000,000
<br /> Per Statute E.L. Disease-Each Em $1,000,000
<br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached if more space is required)
<br /> This Voids and Replaces Previously Issued Certificate Dated 05/13/2025 WITH ID: W39002577. Tu Tran Digitally signed by
<br /> P Y Tu Tran Nguyen
<br /> Nguyen 111 t130S-0700'9
<br /> WC Policies:
<br /> Policy # UB-8P793534-25-51-K - covers all other states.
<br /> Policy # UB-8P760619-25-51-R - covers AZ, MA, WI only. APPROVED
<br /> SEE ATTACHED
<br /> By Tu Tran Nguyen at 11:12 am,May 19,2025
<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 /> ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> City of Santa Ana
<br /> AUTHORIZED REPRESENTATIVE
<br /> 20 Civic Center Plaza (M-30)
<br /> P.OBox , C San
<br /> Santa Anaa, CA 92702-1988
<br /> ©1988-2016 ACORD CORPORATION. All rights reserved.
<br /> ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD
<br /> SR ID: 27763033 BATCH: 3961429
<br />
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