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NORTDIG04C CRUSSELL
<br /> ,d►coRo CERTIFICATE OF LIABILITY INSURANCE F
<br /> DATE(MM/DD/YYYY)
<br /> 11/4/2025
<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#OD44424 CONTACT Cindy Russell,CIC,CISR,CRM
<br /> NAME:
<br /> INSU RICA PHONE FAX
<br /> 8500 Stockdale Highway,Suite 200 (A/C,No,Ext):(661)316-5172 (A/C,No):(661)281-4992
<br /> Bakersfield,CA 93311 E-MAIL-ADDRESS:Cindy.Russell@INSURICA.com
<br /> INSURERS AFFORDING COVERAGE NAIC#
<br /> INSURER A:CrUm&Forster Specialty Insurance Company 44520
<br /> INSURED INSURER B:General Insurance Company of America 24732
<br /> Northern Digital,Inc. INSURER C:State Compensation Insurance Fund(California) 35076
<br /> 4701 Corporate Court INSURER D:
<br /> Bakersfield,CA 93311
<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 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 TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS
<br /> LTR INSD WVD MM/DD/YYYY MM/DD/YYYY
<br /> A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
<br /> CLAIMS-MADE Xrl
<br /> OCCUR EPK162578 10/31/2025 10/31/2026 DAMAGE TO RENTED 50,000
<br /> X X PREMISES Ea occurrence $
<br /> MED EXP(Any oneperson) $ 5,000
<br /> PERSONAL&ADV INJURY $ 1,000,000
<br /> GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 4,000,000
<br /> POLICY PRO ❑ LOC PRODUCTS-COMP/OPAGG $ 4,000,000
<br /> JECT
<br /> OTHER: $
<br /> B AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000
<br /> Ea accident $
<br /> X ANY AUTO X BAS66638970 10/31/2025 10/31/2026 BODILY INJURY Perperson) $
<br /> OWNED SCHEDULED
<br /> AUTOS ONLY AUTOS BODILY INJURY Per accident $
<br /> X HIRED X NON-OWNED PROPERTY DAMAGE
<br /> AUTOS ONLY AUTOS ONLY Per accident $
<br /> A UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 2,000,000
<br /> X EXCESS LIAB CLAIMS-MADE X X EFX139310 10/31/2025 10/31/2026 AGGREGATE $ 2,000,000
<br /> DED RETENTION$ $
<br /> C WORKERS COMPENSATION X PER
<br /> AND EMPLOYERS'LIABILITY STATUTE EERR
<br /> 932701825 10/31/2025 10/31/2026 1,000,000
<br /> ANY PROPRIETOR/EXCLUDED?
<br /> R/EXECUTIVE ❑ X E.L.EACH ACCIDENT $
<br /> OF EXCLUDED? N/A
<br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000
<br /> If yes,describe under 1,000,000
<br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $
<br /> A Prof Liability X EPK162578 10/31/2025 10/31/2026 Each Prof Liab Cond 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,its officers,officials,employees,and volunteers are an additional insured with respects to General Liability and Excess Liability coverage if required
<br /> or agreed to in a written contract subject to policy provisions and limitations,endorsements attached.
<br /> General Liability coverage is primary and non-contributory if required or agreed to in a written contract subject policy provisions and limitations,
<br /> endorsement attached.
<br /> Waiver of Subrogation applies with respects to General Liability,Auto Liability,Workers Compensation,Excess Liability and Professional Liability if required
<br /> or agreed to in a written contract subject to policy provisions and limitations,endorsements attached.
<br /> 30 Day Notice of Cancellation to holder applies
<br /> SEE ATTACHED ACORD 101 APPROVED
<br /> CERTIFICATE HOLDER CANCELLATION By Tu Tran Nguyen at 10:45 am,Nov 05,2025
<br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> City of Santa Ana THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br /> Y ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> 20 Civic Center Plaxa(M-30)
<br /> P>O>Boc 1988 y
<br /> Santa Ana,CA 92702-1988 AUTHORIZED REPRESENTATIVE TuTran Nguyen
<br /> Nguyen Date:
<br /> 002 08 00 5
<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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