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DATE(MM/DD/YYYY)
<br /> A�" CERTIFICATE OF LIABILITY INSURANCE 8/27/2025
<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 CONTACT
<br /> NAME: Helen Jang
<br /> AssuredPartners Design Professionals Insurance Services, LLC PHONE FAX
<br /> 3697 Mt. Diablo Blvd Suite 230 A/C No Ext: 626-696-1892 (A/C,No):
<br /> E-MLafayette CA 94549 ADDRESS: CertsDesignPro@AssuredPartners.com
<br /> INSURER(S)AFFORDING COVERAGE NAIC#
<br /> License#:6003745 INSURERA:Westchester Surplus Lines Insurance Company 10172
<br /> INSURED EARTMEC-01 INSURERB: RLI INSURANCE COMPANY 13056
<br /> Earth Mechanics, Inc INSURERC: CONTRACTORS BONDING AND INSURANCE 37206
<br /> 17800 Newhope St Ste B
<br /> Fountain Valley CA 92708 INSURERD:
<br /> INSURER E:
<br /> INSURER F:
<br /> COVERAGES CERTIFICATE NUMBER:742079355 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 EFF POLICY EXP LIMITS
<br /> LTR INSD WVD POLICY NUMBER MM/DD MM/DD
<br /> B X COMMERCIAL GENERAL LIABILITY Y Y RKB0200055 9/1/2025 9/1/2026 EACH OCCURRENCE $1,000,000
<br /> CLAIMS-MADE � OCCUR PREMISES DAMAGE TO
<br /> PREMISES Ea occurrence)
<br /> ccurrence $1,000,000
<br /> X Contractual Liab MED EXP(Any one person) $10,000
<br /> Included PERSONAL&ADV INJURY $1,000,000
<br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000
<br /> POLICY� PECOT- LOC PRODUCTS-COMP/OP AGG $2,000,000
<br /> OTHER: $
<br /> B AUTOMOBILE LIABILITY Y Y RKB0200055 9/1/2025 9/1/2026 COMBINED SINGLE LIMIT $1,000,000
<br /> Ea accident
<br /> ANY AUTO BODILY INJURY(Per person) $
<br /> OWNED SCHEDULED BODILY INJURY(Per accident) $
<br /> AUTOS ONLY AUTOS
<br /> X HIRED X NON-OWNED FIR ERTYDAMAGE $
<br /> AUTOS ONLY AUTOS ONLY Per accident
<br /> X NoOwned Auto $
<br /> C X UMBRELLALIAB X OCCUR Y Y CKB0200263 9/1/2025 9/1/2026 EACH OCCURRENCE $5,000,000
<br /> EXCESS LAB CLAIMS-MADE AGGREGATE $5,000,000
<br /> DED X RETENTION$1 n nnn $
<br /> B WORKERS COMPENSATION Y PSW0006370 9/1/2025 9/1/2026 X PER OTH-
<br /> AND EMPLOYERS'LIABILITY Y/N STATUTE ER
<br /> ANYPROPRIETOR/PARTNER/EXECUTIVE N/A E.L.EACH ACCIDENT $1,000,000
<br /> OFFICE R/M EMBER EXCLUDED?
<br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000,000
<br /> If yes,describe under
<br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000
<br /> A Contractors Pollution and G28175590005 9/1/2024 9/1/2026 Per Claim/Annual Aggr $2,000,000
<br /> Transportation Pollution Liab. Per Claim/Annual Aggr $1,000,000
<br /> Included
<br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached if more space is required)
<br /> Insured owns no company vehicles;therefore,hired/non-owned auto is the maximum coverage that applies.Auto Liability is follow form to the General Liability
<br /> Policy. The following policies are included in the underlying schedule of insurance for umbrella/excess liability: General Liability/Auto Liability/Employers
<br /> Liability. 'WC Members Excluded: Kandiah Armulmoli and Hubert Law.
<br /> Project: RFP#23-123, City of Santa Ana Public Works Agency's,On-Call Geotechnical Engineering Services
<br /> City of Santa Ana, its officers,officials,employees,and volunteers are named as an additional insured as respects general liability and auto liability as required
<br /> per written contract. General Liability and Auto Liability are Primary/Non-Contributory per policy form wording. Insurance coverage includes waiver of
<br /> subrogation per the attached endorsement(s).
<br /> SEVERABILITY OF INTERESTS
<br /> See Attached...
<br /> CERTIFICATE HOLDER APPROVED CANCELLATION 30 Day Notice of Cancellation
<br /> By Tu Tran Nguyen at 4:45 pm,Dec 03,2025
<br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br /> Digitallysigned ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> City of Santa Ana TU Tran byTuTran
<br /> Attn: Risk Management Division Nguyen
<br /> 20 Civic Center Plaza Nguyen Date:2025.12.03 AUTHORIZED EPRESENTATIVE
<br /> Santa Ana CA 92702 16:45:48-08'00'
<br /> ©1988-2015 ACORD CORPORATION. All rights reserved.
<br /> ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD
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