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ACORO <br />®14� CERTIFICATE OF LIABILITY INSURANCE <br />UATEIMNI°°"YYY' <br />03/27/2024 <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: N the certificate holder is an ADDITIONAL INSURED, the policy(iss) must have ADDITIONAL INSURED provisions or be endorsed. <br />If SUBROGATION IS WAIVED, subject to the terms and conditions of'io policy, certain policies may require an endorsement. A statement on <br />this certificate doe of confer rights to the igirtificate holder in lieu of I uch e <br />r. <br />re y; ull T�r Insurance Agent (A/C No WkPN°NE,)-F Nn; (626)799-7051 <br />PRODUCER Pacific Agents AIIiAn <br />524 S Rosemead E- IL 'Uli j . . s. <br />�// u MAX; n <br />Pasadena CA 91107 INL 'RERA; CONTINEN AL CASUALTY COMPANY 20443 <br />INSURED INS F. late: 2024.05.20— <br />Argo�se� hiel <br />599 NSURER D: _ <br />e <br />Vn' <br />NSU E <br />San Fernando C� P.340 IMSU ER F. <br />COVERAGES CERTIFICATE NUMB= . 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 15 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 />TYPEOFINSURANCE <br />J OL <br />BUBR <br />POLICY NUMBER <br />PMDO EFF <br />Pip EXP <br />LIMITS <br />X <br />COMMERCIAL GENERAL LIABILITY <br />EACH OCCURRENCE <br />$ 1,000,000 <br />CLAIMS -MADE © OCCUR <br />-DAMAGE TO RENTED <br />PREMME3 Ea o=manwl <br />$ 300,000 <br />MED EX? (Any one arson <br />$ 10,000 <br />PERSONAL $ADVINJURY <br />$ 1,000,000 <br />A <br />X <br />X <br />B6024759005 <br />03/24/2024 <br />03/24/2025 <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />GENERAL AGGREGATE <br />$ 2,000,000 <br />PROD UCTS-COMPIOPAGG <br />$ 2,000,000 <br />X POLICY [gPEQ LOC <br />It <br />OTHER: <br />AUTOMOBILE LIA9ILIIY <br />COMBINED[ ANGLE LIMB <br />a sudden <br />$ <br />BODILY INJURY (Per person) <br />$ <br />ANY AUTO <br />BODILY INJURY (Par scdderl) <br />$ <br />B <br />OWNED SCHEDULED <br />AUTOS ONLY AUTOS <br />HIRED NON -OWNED <br />AUTOS ONLY AUTOS ONLY <br />- <br />PROPERTY DAMAGE <br />eraccidentl <br />$ <br />$ <br />X <br />uMBRELLAUAB <br />OCCUR <br />EACH OCCURRENCE <br />$ 3,000,000 <br />AGGREGATE <br />$ 3,000,000 <br />A <br />EXCESS LLIAM <br />CLAIMSMADE <br />B6024759019 <br />03/24/2024 <br />03/24/2025 <br />DIEDX I RETENTION $ 10,000 <br />$ <br />COMPENSATION <br />WORMERS COMPENSATION <br />wno WORKERS <br />uwmury <br />ANY PROPRIETORIPARTNERIEXECIRIYE YIN <br />OFFICERIMEMBER EXCLUDED? <br />(Mandatory in NH) <br />MIA <br />PER OTH- <br />.— _ .STATUTE_ <br />EL EACH ACCIDENT <br />$ <br />E.L. DISEASE - EA EMPLOYE <br />$ <br />E.L. DISEASE- POLICY LIMIT <br />$ <br />If yes, dewdhe under <br />DESCRIPTION OF OPERATIONS below <br />A <br />Employee Dishonesty, <br />Forgery and. Alteration <br />B6024759005 <br />03/24/2024 <br />03/24/2025 <br />$1,900 deductible <br />$1,000deductible <br />$25,000 <br />$25,000 <br />DESCRIPTION OF OPERATIONS/ LOCATIONS [VEHICLES (ACOR) 101. AddPoon•I Remarks Schedule, may be attached N more space Is required) <br />It is agreed that the City of Santa Ana, Its officers, officials, employees and volunteers are named Additional Insureds on the CGL policy with respect to liability <br />arising out of work or operations performed by or on behalf of the Contractor including materials, parts or equipment furnished in connection with such work or <br />operations. General Liability Form CG 2026 (04/13) is attached. This insurance is also Primary and Non -Contributory with respect to Insurance or self- <br />insurance programs maintained by the City per Form No. CG2001 (01/D4) attached. Any Insurance or self-insurance maintained by the Entity, its officers, <br />officials, employees or volunteers shall be excess of the Contractor's insurance and shall not contribute with it per CG2404 (10/93) attached. It is also agreed <br />that 30 Days' Notice of Cancellation with 10 Days' Notice for Non -Payment of Premium in accordance With the policy provisions. All coverages are subject to <br />City of Santa Ana <br />Risk Management Division <br />20 Civic Center Plaza <br />Santa Ana <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF <br />ACCORDANCE WITH THE POLICY PROI <br />AUTHORIZED REPRESENTATIVE <br />CA 92701��` <br />RukMam�ganenLDMelan <br />o�\C REVIEWEDfi APPROVED BY: <br />R' )' A Acevzcrw <br />®' RHk Management Speclaost <br />® 1988-2015 ACI <br />ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD <br />