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MEKOPRI-01
<br />./"'"PC " CERTIFICATE OF LIABILITY INSURANCE DATE(M/202YYY)
<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 />PIASC Insurance Se �ces, Inc.
<br />5800 S. Eastern AV
<br />Suite 400 n a I e
<br />Los Angeles, CA
<br />INSURED
<br />Mekon Printing, Inc.
<br />Hoan T ng
<br />2421 stcte v e o
<br />Sant C 9270
<br />22292
<br />Financial Benefit 41840
<br />re e I 10346
<br />C(1VFRA(,FC CERTIFICATE P'/IRP <FR• RFVICInKl NIIMRFR-
<br />THIS IS TO CERTIFY THAT THE POLICIES OF INSUP..,NCE 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 />ADDL
<br />INSD
<br />SUBR
<br />WVD
<br />POLICY NUMBER
<br />POLICY EFF
<br />MMIDD/YYYY
<br />POLICY EXP
<br />MMIDD/YYYY
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />CLAIMS -MADE X OCCUR
<br />X
<br />ZH3914586513
<br />5/19/2024
<br />5/19/2025
<br />DAMAGE TO RENTED
<br />PREMISES Ea occurrence
<br />100,000
<br />$
<br />X
<br />MED EXP (Any oneperson)
<br />$ 10,000
<br />GL BROADEN ENDT
<br />PERSONAL & ADV INJURY
<br />$ 1,000,000
<br />GEN'L
<br />AGGREGATE LIMIT APPLIES PER:
<br />GENERAL AGGREGATE
<br />$ 2,000,000
<br />X
<br />POLICY PELT LOC
<br />PRODUCTS - COMP/OPAGG
<br />$ Included
<br />Emp. Ben.
<br />$ 1,000,000
<br />OTHER:
<br />B
<br />AUTOMOBILE
<br />LIABILITY
<br />COMBINED SINGLE LIMIT
<br />Ea accident
<br />1,000,000
<br />$
<br />X
<br />BODILY INJURY Perperson)
<br />$
<br />ANY AUTO
<br />AW3914743413
<br />5/19/2024
<br />5/19/2025
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />BODILY INJURY Per accident
<br />$
<br />X
<br />PROPERTY DAMAGE
<br />ccident
<br />Per accident)
<br />$
<br />HIRED X NON -OWNED
<br />AUTOS ONLY AUTOS ONLY
<br />A
<br />X
<br />UMBRELLA LIAB
<br />X
<br />OCCUR
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />UH3909155012
<br />5/19/2024
<br />5/19/2025
<br />AGGREGATE
<br />$ 1,000,000
<br />DED X RETENTION $ 0
<br />$
<br />C
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY
<br />Y/N
<br />ANY PROPRIETOR/PARTNER/EXECUTIVE
<br />OFFICER/MEMBER EXCLUDED?
<br />(Mandatory in NH)
<br />N / A
<br />EIG287806904
<br />7/1/2023
<br />7/1/2024
<br />X PER OTH-
<br />STATUTE ER
<br />E.L. EACH ACCIDENT
<br />1,000,000
<br />$
<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 />$
<br />A
<br />Printers E&O
<br />ZH3914586513
<br />5/19/2024
<br />5/19/2025
<br />Ded: $1000
<br />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, it's officers, employees, agents and representative are named as Additional Insured in regards to General Liability per COMMERCIAL
<br />GENERAL LIABILITY SPECIAL BROADENING & ENHANCEMENT ENDORSEMENTS, with respects to services provided and/or performed by the Named
<br />Insured as required by written contract, per the attached endorsement.
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREO
<br />The City of Santa Ana ACCORDANCE WITH THE POLICY PRC RiskMougmumtDMslcrn
<br />Attn: Risk Management Division E
<br />20 Civic Center Plaza f REVIEWED & APPROVED BY.
<br />Santa Ana, CA 92702 AUTHORIZED REPRESENTATIVE °% •'j•�;`� .." Aa
<br />vN /. /Cw Risk Management Specialist
<br />ACORD 25 (2016/03) J © 1988-2015 ACORD CORPORATION. All rights reserved
<br />The ACORD name and logo are registered marks of ACORD
<br />
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