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CERTIFICATE 4F LIABILITY INSURANCE DAT1 MMIDDIYYYY) <br /> 11/4/2024 <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 UAOMNTEACr Dolores Muir <br /> Andreini& Company PHONE <br /> 220 West 20th Avenue A Ex : 650-573-1111 FAX Na:650-378-4361 <br /> San Mateo CA 94403 E-MAIL <br /> ADDRESS: dmuir@andreini.com <br /> INSURERS AFFORDING COVERAGE NAIC# <br /> INSURER A:Scottsdale Insurance Company 41297 <br /> INSURED MMCIN-1 INSURER B:West American Insurance Co. 44393 Mehta Mechanical Company, Inc. <br /> Dba: MMC, Inc. INSURERC:Tokio Marine Specialty Ins Co 23850 <br /> 5901 Fresca Drive INSURERD: <br /> La Palma CA 90623 INSURER E <br /> INSURER F <br /> COVERAGES CERTIFICATE NUMBER:1775040751 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 ADD[Sl1BR POLICY EFF POLICY EXP <br /> LTR TYPE OF INSURANCE Ii WVDPOLICY NUMBER MMlDD/Y VYY MMIDDIYYYY LIMITS <br /> A X COMMERCIAL GENERAL LIABILITY Y Y BCS2002025 11/1/2024 11/112025 1OCCURRENCE $1,000,000 <br /> CLAIMS-MADE OCCUR PREM SES(ER occurrence $100,000 <br /> X $5,000 Ded MED EXP(Any one person) $Excluded <br /> PERSONAL 8 ADV INJURY $1,000,000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,DOD <br /> POLICY1XI P�� LOC <br /> PRODUCTS-COMP/OP AGO $2,000,000 <br /> OTHER' <br /> $ <br /> B AUTOMOBILELIABILITY Y Y BAW59017366 11/1/2024 111112025 COMBINED SINGLE LIMIT $ <br /> Ea accident 1,000,000 <br /> X ANY AUTO BODILY INJURY(Per person) $ <br /> OWNED SCHEDULED <br /> AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ <br /> HIRED NON-OWNED PHOPERTYDAMAGE <br /> AUTOS ONLY AUTOS ONLY Per accident $ <br /> Deductible $0 <br /> A UMBRELLA LIAB OCCUR XLS2005547 11/1/2024 111112025 EACH OCCURRENCE $5,100,000 <br /> X EXCESS LAB CLAIMS-MADE <br /> AGGREGATE $S,fl00,000 <br /> DED X RETENTION$ $ <br /> WORKERS COMPENSATION PER I OTH- <br /> AND EMPLOYERS'LIABILITY Y l N STATUTE ER <br /> ANYPROPR I ETORIPARTNERIEXECUTI V E <br /> OFFiCERlMEMBEREXCLUDED? ❑ N 1 A E.L..EACH ACCIDENT $ <br /> Mandatary in NH}I E.L.DISEASE-EA EMPLOYEE <br /> F yes,describe under $ <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ <br /> C $1M Excess Liab excess of PUB887405001 1111/2024 11/1/2025 1.000,000 Excess Liab$5M Excess Liability <br /> DESCRIPTION OF OPERATIONS!LOCATIONS!VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached it more space is required) <br /> Re: RFP 22-147A New Prefabricated Restroom Installation at(4)City Parks <br /> The City of Santa Ana,its officers,officials,employees,and volunteers are included as additional insureds for General Liability per attached forms CG 20 10 <br /> 12-19&CG 20 37 12-19. Waiver of subrogation applies per farm CG 24 04 12-19.Such insurance is primary&non-contributory per form CG20010413. 30 <br /> day notice of cancellation applies per farm UTS-411 02-11. <br /> The City of Santa Ana,its officers,officials,employees,and volunteers are included as additional insureds for Auto Liability per attached form CA 20 48 02 99. <br /> Waiver of subrogation applies per form AC85430618. Such insurance is primary&non-contributory per form AC85430821.30 day notice of cancellation applies <br /> per form CA 88 63 09 12. <br /> Umbrella Liability follows form. These attached endorsements are part of the above listed policies. APPROVED <br /> CERTIFICATE HOLDER CANCELLATION By Cynthia Mora at 11:12am,Jan 06,2025 <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 /> Risk Management Division <br /> 20 CIVIC Center Plaza AUTHORIZED REPRESENTATIVE <br /> Santa Ana CA 92702 <br /> ©1988-2015 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD <br />