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ACC CERTIFICATE OF LIABILITY INSURANCE DATE( /YYYY)
<br /> 07/14/DD/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 Lauren Jaffe
<br /> NAME:
<br /> Jaffe Insurance Agency PHONE (310)827-5050 FAX
<br /> A/C No Ext): A/C,No):
<br /> 13160 MINDANAO WAY#204 E-MAIL Lauren@jatteinsurance.com
<br /> ADDRESS:
<br /> MARINA DEL REY,CA 90292 INSURER(S)AFFORDING COVERAGE NAIC#
<br /> INSURERA: Hartford Underwriters Insurance Company 30104
<br /> INSURED INSURER B: Hartford Accident and Indemnity Company 22357
<br /> 3di Inc INSURER C: Hartford Accident and Indemnity Company 22357
<br /> 3 Pointe Dr.Ste 307 INSURER D:
<br /> INSURER E:
<br /> Brea CA 92821 INSURER F:
<br /> COVERAGES CERTIFICATE NUMBER: 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 POLICY EFF POLICY EXP
<br /> LTR INSD WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS
<br /> X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
<br /> DAM
<br /> CLAIMS-MADE Fx_]OCCUR PREM SES Ea occurrDence $ "000,000
<br /> MED EXP(Any one person) $ 10,000
<br /> A Y Y 72SBABC9000 08/03/2025 08/03/2026 PERSONAL&ADV INJURY $ 1,000,000
<br /> GEN'LAGGREGATE LIMITAPPLIES PER. GENERAL AGGREGATE $ 2,000,000
<br /> X POLICY ❑JECa ❑ LOC PRODUCTS-COMP/OPAGG $ 2,000,000
<br /> OTHER. $
<br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000
<br /> Ea accident
<br /> X ANYAUTO BODILY INJURY(Per person) $
<br /> B OWNED SCHEDULED Y Y 72UECZD5366 08/03/2025 08/03/2026 BODI LY I NJ U RY(Pe r accide nt) $
<br /> AUTOS ONLY AUTOS
<br /> HIRED NON-OWNED PROPERTY DAMAGE $
<br /> AUTOS ONLY AUTOS ONLY Per accident
<br /> Uninsured Motorist $ 1,000,000
<br /> X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 10,000,000
<br /> A EXCESS LIAB CLAIMS-MADE AGGREGATE $Y N 72SBABC9000 08/03/2025 08/03/2026 10,000,000
<br /> DED I X RETENTION $ 10,000
<br /> WORKERS COMPENSATION X1 PER
<br /> STATUTE EORH
<br /> AND EMPLOYERS'LIABILITY YIN 1,000,000
<br /> ANY PROPRIETOR/PARTNER/EXECUTIVE 08/03/2025 08/03/2026 E.L.EACH ACCIDENT $
<br /> C OFFICER/MEMBER EXCLUDED? N/A Y 72WECAM7FEE
<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 /> A Data Breach-Defense&Liab Covg N N 72SBABC9000 08/03/2025 08/03/2026 Limit of Coverage $1,000,000
<br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
<br /> The City of Santa Ana,its officers,officials,employees,and volunteers are added as additional insured as required by written contract in respects to
<br /> General Liability and Auto Liability,per attached.The General Liability policy evidenced herein is Primary&Non-Contributory where required by written
<br /> contract with the named insured.A Waiver of Subrogation is granted in favor of the additional insured with respects to General Liability,Auto Liability and
<br /> Workers'Compensation in accordance with the policy's provisions,per attached.Umbrella coverage extends over the Business Owners Policy,
<br /> Commercial Auto and Workers'Compensation,as per policy provisions,and as provided by The Hartford.NOTE:If a signed written contract is NOT in
<br /> place,then coverage under the Additional Insured/Primary&Non-Contributory/Waiver of Subrogation does NOT apply and is voided.—Additional
<br /> Policies/Coverages are listed on prior Certificate Pages.Consult the FULL packet of documents for additional policy/certificate holder/additional insured.
<br /> CERTIFICATE HOLDER CANCELLATION
<br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> City of Santa Ana Community Development Agency THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN
<br /> 20 Civic Center Plaza ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> Santa Ana CA 92702
<br /> Digitally signed
<br /> Tu Tran byn,Tra AUTHORIZED REPRESENTATIVE
<br /> Nguyen
<br /> APPROVED Nguyen°t22025
<br /> By Tu Tran Nguyen at 2:41 pm,Jul 14,2025
<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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