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DATE(MM/DD/YYYY)
<br /> AC"R" CERTIFICATE OF LIABILITY INSURANCE F04/14/2025
<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 Molly Pierson
<br /> NAME:
<br /> Hawley Insurance;PIAAffiliate aICNN. Ext: (714)528-9600 q/X No: (714)528-6900
<br /> 2729 Saturn Street Ste B E-MAIL su ort hawle insuranceservices.com
<br /> ADDRESS: pp @ y
<br /> INSURER(S)AFFORDING COVERAGE NAIC#
<br /> Brea CA 92821 INSURERA: Accelerant National Insurance Company 10220
<br /> INSURED INSURER B: Palomar Specialty Insurance Company 20338
<br /> Fleetworks Inc.,DBA:Fleetworks INSURER C:
<br /> 14011 Marquardt Ave INSURER D:
<br /> INSURER E:
<br /> Santa Fe Springs CA 90670 INSURER F:
<br /> COVERAGES CERTIFICATE NUMBER: CL2541407567 REVISION NUMBER:
<br /> THIS IS TO CERTIFYTHAT 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 MAYBE 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 UBR POLICY NUMBER MM/DD YYYYMPOLICY EFF O DD YYYY LIMITS
<br /> ICY EXP
<br /> LTR INSD WVD
<br /> X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000
<br /> DAMAGETCLAIMS-MADE �OCCUR PREM SESOEa occurrDence $ 500,000
<br /> MED EXP(Any one person) $ 5,000
<br /> A Y Y N0046PK000707-01 04/30/2025 04/30/2026 PERSONAL&ADV INJURY $ 2,000,000
<br /> GEN'LAGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $ 3,000,000
<br /> X PRO ❑ 3,000,000
<br /> POLICY ElJECT LOC PRODUCTS-COMP/OPAGG $
<br /> OTHER: $
<br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000
<br /> Ea accident
<br /> ANYAUTO BODILY INJURY(Per person) $
<br /> A OWNED X SCHEDULED Y N0046PK000707-01 04/30/2025 04/30/2026 BODILY INJURY(Per accident) $
<br /> AUTOS ONLY AUTOS
<br /> X HIRED NON-OWNED PROPERTY DAMAGE $
<br /> AUTOS ONLY /� AUTOS ONLY Per accident
<br /> $
<br /> X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,000
<br /> A EXCESS LIAR CLAIMS-MADE N0046PK000707-01 04/30/2025 04/30/2026 AGGREGATE $ 1,000,000
<br /> DED I X1 RETENTION$ 10,000 $
<br /> WORKERS COMPENSATION X STATUTE ER
<br /> AND EMPLOYERS'LIABILITY Y/N 1,000,000
<br /> ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $
<br /> B OFFICER/MEMBER EXCLUDED? F NIA PSIC10064-05 07/02/2024 07/02/2025
<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 /> Gargakeepers-Direct Primary Loc 1 &Loc 2 $1,200,000
<br /> A Y N0046PK000707-01 04/30/2025 04/30/2026 Loc 3 $400,000
<br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
<br /> The City of Santa Ana,its officers,officials,employees and volunteers are named as additional insured's with respect to liability arising out of work or
<br /> operations performed by or on behald of the Contractor including materials,parts,or equipment furniches in connection with such work operations.Coverage
<br /> is primary and non-contributory.
<br /> Digitally signed
<br /> Tu Train by Tu Tran
<br /> Nguyen APPROVED
<br /> Nguyen Date:zo�5.o5.0�
<br /> toa9:54-07'00 By Tu Tran Nguyen at 10:19 am,May 07,2025
<br /> CERTIFICATE HOLDER CANCELLATION
<br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN
<br /> City of Santa Ana ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> ATTN:PWA-Fleet
<br /> AUTHORIZED REPRESENTATIVE
<br /> 20 Civic Center Plz,M-11
<br /> Santa Ana CA 92701
<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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