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Client#: 1400052 MIDWETAP1
<br /> DATE(MM/DD/YYYY)
<br /> ACORDTM CERTIFICATE OF LIABILITY INSURANCE 10/24/2025
<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 any rights to the certificate holder in lieu of such endorsement(s).
<br /> PRODUCER CONTACT Jennifer Lake, CISR
<br /> USI Insurance Services, LLC CL PHONE 567-803-4414 FAX
<br /> A/C,No,Ext: INC,No):
<br /> 200 N. Saint Clair Street ADDRIESS: .Jennifer.Lake@usi.com
<br /> Suite 1400
<br /> INSURER(S)AFFORDING COVERAGE NAIC#
<br /> Toledo, OH 43604 Transportation Insurance Company 20494
<br /> INSURERA: p p Y
<br /> INSURED INSURER B:Continental Insurance Company 35289
<br /> Midwest Tape, LLC INSURERC:Continental Casualty Company 20443
<br /> P.O. Box 820 Midwest Employers Casualt Company 23612
<br /> INSURER D: Y P Y
<br /> Holland,OH 43528-0820 INSURER E: Surplus Westchester S lus Lines Insurance Co. 110172
<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 /> ADDLSUBR
<br /> LTR TYPE OF INSURANCE NSR WVD POLICY NUMBER POLICY EFF POLICY EXP LIMITS
<br /> (MM/DD/YYYY) (MM/DD/YYYY)
<br /> A X COMMERCIAL GENERAL LIABILITY X X 6071847392 05/09/2025 05/09/2026 EACH OCCURRENCE $1,000,000
<br /> CLAIMS-MADE 4 OCCUR PREMISES(ERENTED rs nce) $500,000
<br /> OH Stop Gap MED EXP(Any one person) $15,000
<br /> $1mi/$1mi/$1mi PERSONAL&ADV INJURY $1,000,000
<br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000
<br /> PRO-
<br /> POLICY JECT LOC PRODUCTS-COMP/OPAGG $2,000,000
<br /> OTHER: $
<br /> A AUTOMOBILE LIABILITY X X 6071847408 05/09/2025 05/09/202 Ee accBID
<br /> cden SINGLE LIMIT $1,000,000
<br /> X ANY AUTO BODILY INJURY(Per person) $
<br /> OWNED SCHEDULED BODILY INJURY(Per accident) $
<br /> AUTOS ONLY AUTOS
<br /> HIRED NON-OWNED PROPERTY DAMAGE
<br /> X AUTOS ONLY X AUTOS ONLY Per accident $
<br /> B X UMBRELLA LAB X OCCUR X X 6071847425 05/09/2025 05/09/2026 EACH OCCURRENCE s15,000,000
<br /> EXCESS LAB CLAIMS-MADE AGGREGATE s15,000,000
<br /> DED I X RETENTION$0 $
<br /> C WORKERS COMPENSATION X 6071847411 05/09/2025 05/09/202 X STATUTE EERH
<br /> AND EMPLOYERS'LIABILITY
<br /> D ANY PROPRIETOR/PARTNER/EXECUTIVE X EWC009148 05/09/2025 05/09/202 E.L.EACH ACCIDENT $1,000,000
<br /> OFFICER/MEMBER EXCLUDED? N N/A
<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 /> E Cyber Tech E F15620304006 11/09/2025 11/09/2026 $5,000,000/$100K ret
<br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
<br /> Digitallysigned
<br /> Tu Tran byTuTran
<br /> Nguyen
<br /> Nguyen Date:2026.01.13
<br /> The City of Santa Ana, its officers,employees,agents,and representatives are additionally insured . 7 13.26:12-08'00'
<br /> APPROVED
<br /> CERTIFICATE HOLDER CANCELLATION By Tu Tran Nguyen at 1:25 pm,J��J
<br /> City of Santa Ana SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFO
<br /> y THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED
<br /> Risk Management Division ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> 20 Civic Center Plaza 4th Floor
<br /> Santa Ana, CA 92702-0000 AUTHORIZED REPRESENTATIVE
<br /> �- 'e. "55, _
<br /> ©1988-2015 ACORD CORPORATION.All rights reserved.
<br /> ACORD 25(2016/03) 1 of 1 The ACORD name and logo are registered marks of ACORD
<br /> #S51526743/M 51518452 M LKZP
<br />
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