|
DATE(MM/DD/YYYY)
<br /> A�" CERTIFICATE OF LIABILITY INSURANCE 3/10/2026
<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
<br /> NAME: Nancy Barajas
<br /> Foundation Risk Partners dba Millennium Risk Mgmt& Ins Services P�HONN Ext: 818-844-4107 FVC,No:818-638-7907
<br /> 301 E Colorado Blvd Ste 205 (AMAIL
<br /> Pasadena CA 91101 ADDRESS: nancyb@mcsins.com
<br /> INSURER(S)AFFORDING COVERAGE NAIC#
<br /> License#:OM93299 INSURERA: Mt. Hawley Insurance Company 37974
<br /> INSURED TRUECON-01 INSURERB: Ohio Security Insurance Company 24082
<br /> Trueline Construction &Surfacing, Inc. INSURERC: Everest Premier Insurance Company 16045
<br /> P.O. Box 70269
<br /> Riverside CA 92513 INSURERD:American Fire and Casualty Company 24066
<br /> INSURER E:
<br /> INSURER F:
<br /> COVERAGES CERTIFICATE NUMBER:894592046 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 POLICY NUMBER MM/DD MM/DD
<br /> A X COMMERCIAL GENERAL LIABILITY Y Y MGL0201449 7/25/2025 7/25/2026 EACH OCCURRENCE $1,000,000
<br /> CLAIMS-MADE � OCCUR PREMISES DAMAGE TO
<br /> PREMISES Ea occurrence)
<br /> ccurrence $50,000
<br /> X $5K ded-BI/PD/PI MED EXP(Any one person) $5,000
<br /> PERSONAL&ADV INJURY $1,000,000
<br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000
<br /> POLICY� PECOT- C LOC PRODUCTS-COMP/OP AGG $2,000,000
<br /> OTHER: Employee Benefits $1,000,000
<br /> D AUTOMOBILE LIABILITY Y BAA 26 56 94 56 05 7/25/2025 7/25/2026 COMBINED SINGLE LIMIT $1,000,000
<br /> ( ) Ea accident
<br /> X ANY AUTO BODILY INJURY(Per person) $
<br /> OWNED SCHEDULED BODILY INJURY(Per accident) $
<br /> AUTOS ONLY AUTOS
<br /> X HIRED LXX
<br /> NON-OWNED PROPERTYDAMAGE $
<br /> AUTOS ONLY AUTOS ONLY Per accidentX COMP-$1K COLL-$1K $
<br /> A X UMBRELLA LIAB X OCCUR MXL0443073 7/25/2025 7/25/2026 EACH OCCURRENCE $4,000,000
<br /> EXCESS LIAB CLAIMS-MADE AGGREGATE $4,000,000
<br /> DED X RETENTION$ $
<br /> C WORKERS COMPENSATION Y 7600016618251 7/25/2025 7/25/2026 X PER OTH-
<br /> AND EMPLOYERS'LIABILITY Y/N STATUTEI ER
<br /> ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $1,000,000
<br /> OFFICE R/M EMBER EXCLUDED? ❑ N/A
<br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000,000
<br /> If yes,describe under
<br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000
<br /> B Business Personal Property BKS(26)56 94 56 05 7/25/2025 7/25/2026 Limit 89,907
<br /> Deductible 1,000
<br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
<br /> Subject to all policy terms,exclusions and conditions.
<br /> Re: RFP 22-123:On-Call Court Resurfacing.
<br /> City of Santa Ana, its City Council,officers,officials,employees,agents,and volunteers,where required by written contract,are named as additional insured for
<br /> General Liability for ongoing&completed operations with per project aggregate&primary wording;with waiver of subrogation for GL,Auto and WC;all per
<br /> forms attached for review.*30 day notice of cancellation/10 days notice for non-payment of premium.
<br /> APPROVED
<br /> CERTIFICATE HOLDER CANCELLATION By TO Tran Nguyen at 10:21 am,Mar 12,2026
<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 /> 20 Civic Center Plaza
<br /> P.O. Box 1988 AUTHORIZED REPRESENTATIVE
<br /> Santa Ana CA 92702 C'2'elc' //. ��
<br /> ©1988-2015 ACORD CORPORATION. All rights reserved.
<br /> ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD
<br />
|