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<br />ACORN® CERTIFICATE OF LIABILITY INSURANCE
<br />DATE (MM/DD/YYYY)
<br />11 /14/2025
<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
<br />Vazquez Prado Insurance Services
<br />18100 Von Karman Ave, Suite 890
<br />CONTACT
<br />AME:
<br />NPHONE
<br />AIC No Ext : 949-536-5602 A/C, No): 844-274-0020
<br />ADDRESS: certificates vaz uez rado.com
<br />Irvine, CA 92612
<br />INSURER(S) AFFORDING COVERAGE
<br />NAIC #
<br />INSURER A: Scottsdale Insurance Company
<br />41297
<br />INSURED
<br />INSURER B : Coast National Insurance Company
<br />25089
<br />J and A Engineering Corporation
<br />DBA J and A Fence
<br />INSURER C: Omaha National Casualty Company
<br />32107
<br />824 North Todd Ave
<br />INSURERD:
<br />Azusa, CA 91702
<br />INSURER E 7
<br />INSURER F :
<br />COVERAGES CERTIFICATE NUMBER: 27017345 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
<br />LTR
<br />TYPE OF INSURANCE
<br />A
<br />INSD
<br />WVD
<br />POLICY NUMBER
<br />POLICY EFF
<br />(MM/DD/YYYY)
<br />POLICY EXP
<br />(MM/DD/YY)
<br />W
<br />LIMITS
<br />A
<br />�/
<br />COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE �/ OCCUR
<br />X
<br />X
<br />RBS0339478
<br />11 /20/2025
<br />11 /20/2026
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />DAMAGE TO RENTED
<br />PREMISES Ea occurrence
<br />$ 50,000
<br />MED EXP (Any one person)
<br />$ 5,000
<br />PERSONAL & ADV INJURY
<br />$ 1,000,000
<br />GEN'L
<br />GENERAL AGGREGATE
<br />$ 2,000,000
<br />AGGREGATE LIMIT APPLIES PER:
<br />POLICY PROJECT LOC
<br />PRODUCTS - COMP/OP AGG
<br />$ 2,000,000
<br />OTHER:
<br />B
<br />AUTOMOBILE
<br />LIABILITY
<br />X
<br />X
<br />M00-0093815-00
<br />08/01/2025
<br />02/01/2026
<br />Ea accident
<br />$ 1,000,000
<br />BODILY INJURY (Per person)
<br />$
<br />ANY AUTO
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />BODILY INJURY (Per accident)
<br />$
<br />PROPERTY DAMAGE
<br />Per accident
<br />$
<br />HIRED NON -OWNED
<br />AUTOS ONLY AUTOS ONLY
<br />A
<br />UMBRELLA LIAB
<br />✓
<br />OCCUR
<br />LS1230325
<br />11/20/2025
<br />11/20/2026
<br />EACH OCCURRENCE
<br />$ 4,000,000
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />AGGREGATE
<br />4,000,000
<br />DED
<br />RETENTION $
<br />$
<br />C
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY
<br />ANYPROPRIETOR/PARTNER/EXECUTIVE
<br />X
<br />ONCCO7013402-03
<br />11/01/2025
<br />11/01/2026
<br />✓ STATUTE ER
<br />E.L. EACH ACCIDENT
<br />$ 1,000,000
<br />OFFICER/MEMBER EXCLUDED?
<br />(Mandatory in NH)
<br />NIA
<br />E.L.DISEASE - EA EMPLOYEE
<br />$ 1,000,000
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE- POLICY LIMIT
<br />$ 1,000,000
<br />A
<br />INLAND MARINE
<br />RBS0335430
<br />06/10/2025
<br />06/10/2026
<br />LIMIT OF INSURANCE $ 78,936
<br />DESCRIPTION OF OPERATIONS/ LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
<br />City of Santa Ana, PWA- Facilities, its officers, officials, employees, and volunteers are listed as an additional insured per
<br />the blanket additional insured endorsement if required by written contract or agreement.
<br />signed by
<br />TU Tran
<br />TugTralnyNguyen
<br />Nguyen 08 16 30� S 08'00'
<br />APPROVED
<br />CERTIFICATE HOLDER CANCELLATION I By Tu Tran Nguyen at 8:16 am, Nov 25, 2025
<br />City of Santa Ana SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />PWA- Facilities THE EXPIRATION DATE THEREOF, 30 DAY NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />20 Civic Center Plaza
<br />Santa Ana, Ca. 92702 AUTHORIZED REPRESENTATIVE
<br />/ Socrates Vazquez
<br />© 1988-2015 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD
<br />27017345 1 RBS0339478 I M00-0093815-00 I XLS1230325 I ONCCO7013402-03 I RBS0335430 1 25/26 Master Certificate 11/14/2025 09:19:26 AM(PDT)
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