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ENVIPLA-02 TAKAPUK
<br />'4coRo CERTIFICATE OF LIABILITY INSURANCE
<br />FDATE(MM/DD/YYYY)
<br />0/21 /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 # OE67768
<br />IOA Insurance Services
<br />3875 Hopyard Road
<br />Suite 200
<br />Pleasanton, CA 94588
<br />CONTACT katalina takapu
<br />NAME:
<br />PHONE FAX
<br />(A/C, No, Ext): (925) 416-7862 (A/C, No): (925) 416-7869
<br />ADDRESS:
<br />INSURERS AFFORDING COVERAGE
<br />NAIC #
<br />INSURER A: Continental Casualty Company
<br />20443
<br />INSURED
<br />INSURER B: Hartford Casualty Insurance Company
<br />29424
<br />INSURER C:
<br />Environment Planning Development Solutions Inc dba EPD
<br />Solutions Inc
<br />3333 Michelson Dr., Suite 500
<br />INSURER D :
<br />INSURER E:
<br />Irvine, CA 92612
<br />INSURER F :
<br />COVERAGES CERTIFICATE NUMBER- REVISION NUMBER- 2
<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
<br />LTR
<br />TYPE OF INSURANCE
<br />ADDL
<br />INSD
<br />SUBR
<br />WVD
<br />POLICY NUMBER
<br />POLICY EFF
<br />MM/DD/YYYY
<br />POLICY EXP
<br />MM/DD/YYYY
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />EACH OCCURRENCE
<br />$ 2,000,000
<br />CLAIMS -MADE X OCCUR
<br />X
<br />X
<br />B6025654530
<br />913012025
<br />913012026
<br />DAMAGE TO RENTED
<br />PREMISES Ea occurrence
<br />1,000,000
<br />$
<br />MED EXP (Any oneperson)
<br />$ 10,000
<br />PERSONAL & ADV INJURY
<br />$ 2,000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />GENERAL AGGREGATE
<br />$ 4,000,000
<br />POLICY X JECT LOC
<br />PRODUCTS - COMP/OP AGG
<br />$ 4,000,000
<br />$
<br />OTHER:
<br />A
<br />AUTOMOBILE
<br />LIABILITY
<br />COMBINED SINGLE LIMIT
<br />Ea accident
<br />1,000,000
<br />$
<br />BODILY INJURY Perperson)
<br />$
<br />ANY AUTO
<br />X
<br />X
<br />B6025654530
<br />913012025
<br />913012026
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />BODILY INJURY Per accident
<br />$
<br />X
<br />PROPERTY DAMAGE
<br />Per accident)
<br />ccident
<br />$
<br />HIRED X NON -OWNED
<br />AUTOS ONLY AUTOS ONLY
<br />$
<br />A
<br />X
<br />UMBRELLA LIAB
<br />X
<br />OCCUR
<br />EACH OCCURRENCE
<br />$ 4,000,000
<br />AGGREGATE
<br />$ 4,000,000
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />X
<br />X
<br />B6025663132
<br />913012025
<br />913012026
<br />DED I X I RETENTION $ 10,000
<br />$
<br />B
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY
<br />YIN
<br />ANY PROPRIETOR/PARTNER/EXECUTIVE
<br />OFFICER/MEMBER EXCLUDED?
<br />(Mandatory in NH)
<br />N /A
<br />X
<br />57WEGAC20BW
<br />913012025
<br />913012026
<br />X PER OTH-
<br />STATUTE ER
<br />E.L. EACH ACCIDENT
<br />1,000,000
<br />$
<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 />$
<br />A
<br />Professional Liab.
<br />X
<br />EEH591923312
<br />913012025
<br />913012026
<br />Per Claim
<br />4,000,000
<br />A
<br />Professional Liab.
<br />X
<br />EEH591923312
<br />913012025
<br />913012026
<br />Aggregate
<br />5,000,000
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
<br />RE: On -Call Agreement - Agreement No. A-2023-194-03
<br />As required by Certificate Holder written contract or agreement, in -addition to (if applicable) the governing written contract or agreement: (1) Commercial
<br />General Liability policy shall include (a) additional insured coverage and contain (b) primary & non-contributory and (c) waiver of subrogation provisions for
<br />any additional insured; (2) to the extent applicable, Automobile Liability policy shall include (a) additional insured coverage and contain (b) primary & non-
<br />contributory and (c) waiver of subrogation provisions for any additional insured; (3) to the extent applicable, Commercial Excess Liability policy shall apply
<br />on a follow -form basis, excess of commercial general liability, automobile liability and employers' liability policy(ies) with such coverage being concurrent
<br />with underlying insurance; (4) to the extent applicable, Workers Compensation and Employers' Liability policy shall include a waiver of subrogation provision;
<br />SEE ATTACHED ACORD 101
<br />CERTIFICATE HOLDER APPROVED CANCELLATION
<br />By Tu Tran Nguyen at 11:18 am, Oct 22, 2025
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />Tu Tran Dggtauysigned by ACCORDANCE WITH THE POLICY PROVISIONS.
<br />Tu Tran Nguyen
<br />Date: 2025.10.22
<br />Nguyen ,1185,-0,-o0
<br />AUTHORIZED REPRESENTATIVE
<br />City of Santa Ana, Planning and Building Agency
<br />20 Civic Center Plaza
<br />Santa Ana CA 92701 1
<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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