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CWEOOOO-01 KSITYAMALA
<br />d►c , CERTIFICATE OF LIABILITY INSURANCE
<br />��
<br />DATE D/YYYY)
<br />11/6/2/6/2025
<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 License # 0757776
<br />CONTACT Donna Jones
<br />NAME:
<br />PHONE FAX
<br />(A/C, No, Ext): (A/C, No):
<br />HUB International Insurance Services Inc.
<br />600 Corporate Pointe Suite 600
<br />Culver City, CA 90230
<br />E-MAIL-ADDRESS: donna.jones@hubinternational.com
<br />INSURERS AFFORDING COVERAGE
<br />NAIC #
<br />INSURER A: Crum & Forster Specialty Insurance Company
<br />44520
<br />INSURED
<br />INSURER B : National Fire & Marine
<br />20079
<br />CWE
<br />1561 E. Orangethorpe Avenue
<br />INSURERC: Pacific Compensation Insurance Company
<br />11555
<br />Suite 240
<br />INSURER 7
<br />INSURER E :
<br />Fullerton, CA 92831
<br />INSURER F :
<br />COVERAGES CERTIFICATE NUMRFR- REVISION NUMRFR-
<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
<br />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 />MM/DD/YYYY
<br />POLICY EXP
<br />MM/DD/YYYY
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />EACH OCCURRENCE
<br />$
<br />2,000,000
<br />CLAIMS -MADE X OCCUR
<br />X
<br />X
<br />EPK-149909
<br />12/8/2024
<br />12/8/2025
<br />DAMAGE TO RENTED
<br />PREMISES Ea occurrence
<br />$
<br />100,000
<br />MED EXP (Any oneperson)
<br />$
<br />10,000
<br />PERSONAL & ADV INJURY
<br />$
<br />2,000,000
<br />GENT
<br />AGGREGATE LIMIT APPLIES PER:
<br />GENERAL AGGREGATE
<br />$
<br />4,000,000
<br />POLICY � PEA LOC
<br />PRODUCTS - COMP/OP AGG
<br />$
<br />4,000,000
<br />POLLUTION LIABI
<br />$
<br />2,000,000
<br />OTHER:
<br />B
<br />AUTOMOBILE
<br />LIABILITY
<br />COMBINED SINGLE LIMIT
<br />Ea accident
<br />$
<br />1,000,000
<br />BODILY INJURY Perperson)
<br />$
<br />ANY AUTO
<br />X
<br />72APBO11724
<br />6/6/2025
<br />6/6/2026
<br />OWNED SCHEDULED
<br />AUTOS ONLY X 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 />UMBRELLA LIAB
<br />X
<br />OCCUR
<br />EACH OCCURRENCE
<br />$
<br />1,000,000
<br />X
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />EFX-126836
<br />12/8/2024
<br />12/8/2025
<br />AGGREGATE
<br />$
<br />1,000,000
<br />DED RETENTION $
<br />$
<br />C
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY
<br />ANY PROPRIETOR/ R/EXECUTIVE
<br />EXCLU
<br />OFFICER/MEMBER EXCLUDED?
<br />(Mandatory in NH)
<br />N / A
<br />X
<br />1025483
<br />12/1 /2024
<br />12/1 /2025
<br />X PER OTH-
<br />STATUTE ER
<br />E.L. EACH ACCIDENT
<br />$
<br />1,000,000
<br />E.L. DISEASE - EA EMPLOYEE
<br />$
<br />1,000,000
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE - POLICY LIMIT
<br />$
<br />1,000,000
<br />A
<br />Professional Liabili
<br />X
<br />EPK-149909
<br />12/8/2024
<br />12/8/2025
<br />Each Wrongful Act
<br />2,000,000
<br />A
<br />Professional Liabili
<br />X
<br />EPK-149909
<br />12/8/2024
<br />12/8/2025
<br />Aggregate
<br />4,000,000
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
<br />Re: Project Name: A-2023-088-08 Santa Ana On -Call Engineering Services.
<br />Revised 11-06-2025 This certificate rescinds and supersedes any and all prior certificates issued on behalf of the Named Insured.
<br />The City of Santa Ana, 20 Civic Center Plaza, Santa Ana, California 92701; officers, agents, employees, representatives and volunteers are Additional Insured
<br />with regard to General Liability when required by written contract per the attached endorsement forms #EN0111 02/11 and #EN0147 11/11. Primary
<br />& Non -
<br />Contributory wording applies with regard to General Liability when required by written contract per the attached endorsement form #EN0147
<br />11/11. Waiver of
<br />Subrogation with regard to General Liability applies when required by written contract per the attached endorsement form #EN0147 11/11. Per Project
<br />SEE ATTACHED ACORD 101
<br />CERTIFICATE HOLDER APPROVED CANCELLATION
<br />By Tu Tran Nguyen at 10:25 am, Nov 12, 2025
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />City of Santa Ana THE EXPIRATION DATE THEREOF, NOTICE WILL BE
<br />Y Digitallysigned ACCORDANCE WITH THE POLICY PROVISIONS.
<br />Attn: Public Works Agency TU Tran byTuTran
<br />DELIVERED IN
<br />CIP/Design Engineering Nguyen
<br />20 Civic Center Plaza, M-36 Nguyen Date:2025.11.12 AUTHORIZED REPRESENTATIVE
<br />Santa Ana, CA 92701 10:26:30-08'00' �
<br />ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved.
<br />The ACORD name and logo are registered marks of ACORD
<br />
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