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CERTIFICATE OF LIABILITY INSURANCE
<br />DATE IMMIDDIYYYY)
<br />0612912023
<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 />is an
<br />It tl th
<br />to he
<br />17901 Von Kerman Avenue, Suite 1100
<br />//�� (949) 33999�-58000; Licensee 404371
<br />/�� ifn: �ergb2r�hE ue ors r
<br />INSURED D�h91- ���KCC444
<br />PlaceWofks, Inc
<br />3 MacArthur Place, Suite 1100
<br />Santa Ana, CA 92707
<br />Angle Acev
<br />Date: 2024.
<br />the poll y ies) must have ADDITIONAL INSURED provisions or be endorsed.
<br />@II&IDIfiertain policies may require an endorsement. A statement on
<br />COVERAGES CERTIFICATE NUMBER: LOS-002212046-31 REVISION NUMBER: 12
<br />25674
<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 />AODL
<br />SUER
<br />POUCYNUMBER
<br />MMIDD�
<br />MMIDDIY VPY
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />C
<br />CLAIMS -MADE � OCCUR
<br />X
<br />X
<br />EPK144434
<br />07101/2023
<br />0710112024
<br />EACH OCCURRENCE
<br />$ 5,000,000
<br />A A ET RENTED
<br />PREMISES Ea oomneto
<br />50,000
<br />X
<br />MED EXP (Any one person)
<br />$ 5,000
<br />BI & PD Dad. $5,000
<br />PERSONAL &ADV INJURY
<br />$ 6,000,000
<br />GEN'L
<br />X
<br />AGGREGATE LIMIT APPLIES PER.
<br />POLICY JECT LOC
<br />GENERAL AGGREGATE
<br />$ 5,000,000
<br />PRODUCTS-COMPIOPAGG
<br />$ 5,000,000
<br />Contractors Pollution
<br />S 5,000,000
<br />OTHER:
<br />B
<br />AUTOMOBILE
<br />LIABILITY
<br />X
<br />X
<br />BA1N96406A2343G
<br />0710112023
<br />onoi m
<br />COMBINED SINGLE _LIMIT
<br />Ea accid.r
<br />IS 1,000,000
<br />X1AUTOS
<br />BODILY INJURY (Per person)
<br />S
<br />ANY AUTO
<br />OWNED SCHEDUTOSULED
<br />AUTOS ONLY A
<br />BODILY INJURY (Per accident)
<br />$
<br />HIRED HNON-0WNED
<br />ONLY AUTOS ONLY
<br />PROPERTYDAMAGE
<br />Per accident
<br />$
<br />Comp/Coll Deductibles
<br />$ 1,000
<br />UMBRELLA LIAR
<br />X
<br />OCCUR
<br />EX6J3287562343
<br />WI01/2023
<br />07101/2024
<br />EACH OCCURRENCE
<br />$ 4,000,000
<br />X
<br />AGGREGATE
<br />$ 4,000,000
<br />EXCESS LIAR
<br />CLAIMS -MADE
<br />DED
<br />I I RETENTION$
<br />$
<br />B
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY YIN
<br />OFFICE IMEMB REXC UDED?ECUTIVE
<br />(MandaRIMEMNEREXCLUDEO9
<br />NH)
<br />NIA
<br />U87K7286762343G
<br />00112023
<br />07012024
<br />X I PER OTH-
<br />STATU TE ER
<br />E. L. EACH ACCIDENT
<br />$ 1,000,000
<br />E. L. DISEASE -EA EMPLOYEE
<br />$ 1,000,000
<br />It yes dtoryln
<br />Dyes, IPTION under
<br />DESCRIPTION OF OPERATIONS below
<br />E. L. DISEASE -POLICY LIMIT
<br />$ 1,000,000
<br />A
<br />Enors & Omissions -Claims Made
<br />EPKI44434
<br />)T01/2023
<br />07/01/2024
<br />Each Claim/Aggregate
<br />5,000,000
<br />Rare Dates: See 2nd Page
<br />DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if mare apace is required)
<br />Re: Operations performed by the named insured for the candidate holder
<br />City of Santa Ana, its officers, agents, employees, and volunteers are included as additional insured where required by written contract with respect to General and Auto Liability. This insurance is primary and non-
<br />contributory over any existing insurance and limited to liability arising out of the operators of the named insured and where required by written contract with respect to General Liability. Waiver of subrogation is
<br />applicable where required by written contract with respect to General and Auto Liability.
<br />City of Santa Ana
<br />Risk Management Division
<br />20 Civic Center Plaza, 4th Floor
<br />Santa Ana, CA 92701
<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 PRE
<br />Em
<br />©1988-2016 ACORD
<br />vla ..=I„�, _'DMonganmtDlW�
<br />Risk Management Spedalist
<br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
<br />
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