|
A1� �® CERTIFICATE OF LIABILITY INSURANCE
<br />DATE (MM/DDIYYYY)
<br />10/3/2025
<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 />CONTACT
<br />NAME: Matthew Cowan
<br />Sandco Services Inc dba The Julian Summers Insurance Agency
<br />b Y
<br />PHONE,FAX
<br />PHONE 310 361-5630
<br />E , Ext : (- (A/C, No):
<br />ADDRESS: randa@sandco-ins.com
<br />2629 Manhattan Ave
<br />INSURER(S) AFFORDING COVERAGE
<br />NAIC #
<br />Spite #270
<br />INSURER A : TRAVELERS IND CO OF CT
<br />25682
<br />Hermosa Beach CA 90254
<br />INSURED
<br />INSURER B: TRAVELERS PROP CAS CO OF AMER
<br />25674
<br />INSURER C : LLOYDS OF LONDON
<br />122000
<br />MULTI W SYSTEMS INC.
<br />INSURER D :
<br />2615 STROZIER AVE
<br />INSURER E :
<br />INSURER F :
<br />EL MONTE CA 917332021
<br />COVERAGES CERTIFICATE NUMBER: 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 />LTR
<br />TYPE OF INSURANCE
<br />INSD
<br />WVD
<br />POLICY NUMBER
<br />(MMIDD/YYYY)
<br />(MMIDDIYYYY)
<br />LIMITS
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />CLAIMS -MADE F x1OCCUR
<br />PREMISES (Ea occurrence)
<br />$ 300,000
<br />MED EXP (Any one person)
<br />$ 5,000
<br />PERSONAL a ADV INJURY
<br />$ 1,000,000
<br />A
<br />Y
<br />Y
<br />Y-630-7J22389A-TCT-25
<br />08/01/2025
<br />08/01/2026
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />GENERAL AGGREGATE
<br />$ 2,000,000
<br />POLICY ❑X JE C ❑ LOC
<br />PRODUCTS - COMP/OP AGG
<br />$ 2,000,000
<br />$
<br />OTHER:
<br />AUTOMOBILE
<br />LIABILITY
<br />(Ea accident)
<br />$ 1,000,000
<br />X
<br />BODILY INJURY (Per person)
<br />$
<br />ANY AUTO
<br />B
<br />AUTOS OWNEDONLY AUTOS SCHEDULED
<br />Y
<br />Y
<br />BA-3N112945-25-14-G
<br />08/01/2025
<br />08/01/2026
<br />BODILY INJURY (Per accident)
<br />$
<br />HIRED NON -OWNED
<br />AUTOS ONLY AUTOS ONLY
<br />(Per accident)
<br />$
<br />Comp/Collision Ded
<br />$ 1,000
<br />X
<br />UMBRELLA LIAB
<br />X
<br />OCCUR
<br />EACH OCCURRENCE
<br />$ 4,000,000
<br />B
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />Y
<br />Y
<br />CUP-7J229094-25-14
<br />08/01/2025
<br />08/01/2026
<br />AGGREGATE
<br />$ 4,000,000
<br />DED
<br />I
<br />I RETENTION $
<br />EBLIA
<br />$ 1,000,000
<br />B
<br />WORKERS COMPENSATION
<br />ND EMPLOYERS' LIABILITY Y I N
<br />ANY PROPRIETOR/PARTNER/EXECUTIVE
<br />OFFICERNEMBER EXCLUDED?
<br />(Mandatory in NH)
<br />NIA
<br />Y
<br />UB-A1688932-25-14-G
<br />08/01/2025
<br />08/01/2026
<br />OTH-
<br />X STATUTE ER
<br />E.L. EACH ACCIDENT
<br />$ 1,000,000
<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 />Design/Engineering PL
<br />17000,000
<br />C
<br />Professional Liability
<br />PF0213IA24
<br />08/01/2025
<br />08/01/2026
<br />Pollution Liability
<br />17000,000
<br />Mold Liability
<br />1,000,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
<br />City of Santa Ana listed as additional insured where required by written contract. Waiver of subrogation applies. Tu Tran Digitally signed b
<br />Tu Tran Nguyen
<br />Date: 205.10.0
<br />Nguyen
<br />09:49:33-0700?
<br />APPROVED
<br />!`COTICl/'A-rC Un1 nco rA KIPCI I ATlnni By Tu Tran Nguyen at 9:49 am, Oct 07, 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
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />Heidi Chou
<br />AUTHORIZED REPRESENTATIVE
<br />215 S. Center St., M-85
<br />Santa Ana CA 92701
<br />© 1988-2015 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
<br />
|