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Client#: 2002815
<br />SMCON Tracy Digitally signed
<br />ACORD.CERTIFICATE OF LIABILITY INSURANCE I D4aM%11VA.10.18
<br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOL I
<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 any rights to the certificate holder in lieu of such endomement(s).
<br />PRODUCER
<br />ONTA CCT Christine Torrance
<br />NAME:
<br />USI Insurance Services LLC
<br />PHONE 602 666-4830 FAX 610 537-2283
<br />E,d : ac, Na
<br />E
<br />2375 E. Camelback Road, Suite 250
<br />E-MAIL
<br />ADDRESS: christine.torrance@usi.com
<br />Phoenix, AZ 85016
<br />INSURERS) AFFORDING COVERAGE
<br />NAIC #
<br />877 468.6516
<br />INSURER A: Everest Indemnity Insurance Company
<br />10851
<br />INSURED
<br />INSURER B : State Compensation Insurance Fund of CA
<br />35076
<br />5M Contracting Inc.
<br />Everest Denali Insurance Company
<br />INSURER L: P Y
<br />16044
<br />2681 Dow Ave, Suite C7
<br />Tustin, CA 92780
<br />INSURER D
<br />INSURER E
<br />INSURER F:
<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 CONTRACTOR 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 />LTRR
<br />TYPE OF INSURANCE
<br />INRL
<br />BA
<br />MD
<br />POLICY NUMBER
<br />MWODYEFF
<br />MWDOYEXP
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERALLIABILITY
<br />X
<br />X
<br />EFlMLOO168231
<br />1/01/2023
<br />0110112024
<br />EACHOCCURRENCE
<br />$2000,000
<br />CLAIMS -MADE [X OCCUR
<br />PREMISES EdnocEnenca
<br />$50,000
<br />X
<br />MED EXP (Any am person)
<br />$5,000
<br />BIIPD:$5,000
<br />PERSONAL B ADV INJURY
<br />$2,000,000
<br />GEN'L
<br />AGGREGATE LIMIT APPLIES PER:
<br />POLICY J JECT LOC
<br />GENERAL AGGREGATE
<br />$3,000,000
<br />PRODUCTS - COMP/OPAGG
<br />$3,000,000
<br />$
<br />OTHER:
<br />C
<br />AUTOMOBILE
<br />LIABILITY
<br />X
<br />X
<br />EFICA00046231
<br />0110112023
<br />01/01/202
<br />Eee INEDtSINGLE LIMIT
<br />1,000,000
<br />BODILY INJURY (Per person)
<br />$
<br />X
<br />ANY AUTO
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />BODILY INJURY (Per amitlent)
<br />-PROPERTY-DAMAGE
<br />$
<br />X
<br />HIRED NON-0WNED
<br />AUTOS ONLY X AUTOS ONLY
<br />Per accident
<br />$
<br />$
<br />A
<br />UMBRELLA LIAR
<br />X
<br />OCCUR
<br />EF1C000125231
<br />1/01/2023
<br />01/01/2024
<br />EACH OCCURRENCE
<br />$5000000
<br />AGGREGATE
<br />s5,000,000
<br />dX
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />DED RETENTION$
<br />$
<br />B
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS LIABILITY V I R
<br />ANY PROPRIETOR/PARTNEWEXECUTIVE
<br />OFFICER/MEMBER EXCLUDED9
<br />N/A
<br />X
<br />9330685
<br />1/01/2023
<br />01/0112024
<br />X PER OTH-
<br />E.L.EACH ACCIDENT
<br />$1 000 000
<br />E.L. DISEASE - EA EMPLOYEE
<br />$1,000,000
<br />(Mandatory in NH)
<br />If,, descnbe under
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE-POLICYLIMIT
<br />I $1,000,000
<br />A
<br />Professional Liab
<br />EFlMLOO168231
<br />0110112023
<br />01101/2024
<br />$1,000,000/$5,000 Ded
<br />PL Retro Date: 1/24/95
<br />A
<br />Contr Pollution
<br />EFlMLOO168231
<br />1/01/2023
<br />0110112024
<br />$10,000,000/$5,000 Ded
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if mare space is required)
<br />General Liability, including completed operations, and Auto Liability include an automatic Additional
<br />Insured endorsement that provides Additional Insured status to the Certificate Holder, only when there is a
<br />written contract or written agreement between the named insured and the certificate holder and with regard
<br />to work performed by or on behalf of the named insured. General Liability, Auto Liability and Workers
<br />Compensation provide a blanket Waiver of Subrogation in favor of the same, when required by written
<br />(See Attached Descriptions)
<br />City of Santa Ana
<br />Risk Management Division
<br />20 Civic Center Plaza
<br />Santa Ana, CA 92702
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />ACORD 25 (2016/03) 1 of 2 The ACORD name and logo are registered marks of ACORD
<br />#S39709251/M38855218
<br />y Ktalemaugelle¢IJIWOI
<br />, RENEWEO$APPROVEDBY:
<br />ACORD C ®; T4"y JAII&
<br />Risk Management Analyst
<br />
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