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C�® DATE(MM/DD/YYYY)
<br /> A
<br /> C� CERTIFICATE OF LIABILITY INSURANCE 5/30/2024
<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: 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
<br /> Patriot Risk& Insurance Services PHONE FAX
<br /> 18952 MacArthur Blvd., Suite#300 IA/C.No.Ext): (949)486-7900 (A/C,No):
<br /> Irvine, CA 92612 • AlLig ItaillFyR{°J ig It Aby NAIL#
<br /> www.patrisk.com , . 6
<br /> II
<br /> INSWRERA: Zurich A ericanlnsuranc Company 16535
<br /> INSURED 'N gleA) GelVeldfanpany 16691
<br /> Mike Prlich &Sons, Inc. in Allied World National Assurance Company 10690
<br /> Elton St. �
<br /> Baldwin Park CA 917
<br /> C eveINSURER o IN� ► ate: 2024.06. 004:24 071nn'
<br /> COVERAGES CERTIFICATE NUMBER: 30.12794 REtlIStON 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 IS SUBJECT TO ALL THE TERMS,
<br /> EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br /> LTRINSR TYPE OF INSURANCE INSD yyyp POLICY NUMBER /YPOLICY EFF POLICY EXP LIMITS
<br /> {MMIDDYYY) IMM/DD/YYYYL
<br /> A i COMMERCIAL GENERAL LIABILITY ,/ / GL07143499-00 8/1/2023 8/1/2024 EACH OCCURRENCE $1,000,000
<br /> CLAIMS-MADE ✓ OCCUR DAMAGE TO RENTED
<br /> PREMISES(Ea occurrence) $300,000
<br /> ✓ $5,000 Deductible MED EXP(Any one person) $5,000 _
<br /> PERSONAL&ADV INJURY $1,000,000
<br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000
<br /> POLICY ✓ ,,pi LOC PRODUCTS-COMP/OPAGG $2,000,000
<br /> OTHER: $
<br /> A AUTOMOBILE LIABILITY BAP7143502-00 8/1/2023 8/1/2024 (EOa aBcideDtj INGLE LIMIT $1,000,000
<br /> `/ ANY AUTO BODILY INJURY(Per person) $
<br /> OWNED SCHEDULED BODILY INJURY(Per accident) $
<br /> _ AUTOS ONLY _ AUTOS _
<br /> HIRED NON-OWNED PROPERTY DAMAGE $
<br /> AUTOS ONLY AUTOS ONLY (Per accident)
<br /> B UMBRELLALIAB I OCCUR TUE405237302 8/1/2023 8/1/2024 EACH OCCURRENCE $10,000,000
<br /> —
<br /> ,,/ EXCESS LIAB CLAIMS-MADE AGGREGATE $10,000,000
<br /> DED RETENTION$ $
<br /> A WORKERS COMPENSATION / WC7143497-00 8/1/2023 8/1/2024 f STATUTE ERH
<br /> AND EMPLOYERS'LIABILITY YI N
<br /> ANYPROPRIETOR/PARTNER/EXECUTIVE n N/A E.L.EACH ACCIDENT $1,000,000
<br /> OFFICER/MEMBEREXCLUDED9
<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 /> C Pollution Liability/Professional Liab 03139429 8/1/2023 8/1/2024 $10,000,000 Policy Aggregate
<br /> Professional:Claims Made Poll:$5,000,000 Occur/$10,000,000 Agg
<br /> Retro Date:5/9/22 Prof Liab: $2,000,000 Occur/Agg
<br /> Pollution: Occurrence
<br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
<br /> RE: RFP#23-182:On-Call Emergency Asphalt Concrete,Concrete,and Stormdrain Repair
<br /> City of Santa Ana,its officers,officials,employees,and volunteers are named as additionally insured as respects General Liability per endorsement
<br /> attached. Primary/non-contributory endorsement attached. Waiver of subro as respects GL and WC attached.
<br /> Excess Liability dec page attached showing the GL in the schedule of underlying
<br /> 30-day notice of cancellation/10-days for non-payment of premium.
<br /> CERTIFICATE HOLDER CANCELLATION
<br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> City of Santa Ana THE EXPIRATION DATE THEREOF. NOTICE WILL BE DELIVERED IN
<br /> Risk Management Division ACCORDANCE WITH THE POLICY PRC\ /y
<br /> 20 Civic Center Plaza, 4th floor e µ,R,�a „t Division ii
<br /> Santa Ana CA 92701
<br /> AUTHORIZED REPRESENTATIVE ti lldi ''i REVIEWED&APPROVED BY:
<br /> Y•4l , `�. d1 li' A
<br /> ,r r'Ia414Ce
<br /> :13EMES i
<br /> I Dave Jacobson
<br /> Risk Management Specialist
<br /> 9 P
<br /> ©1988-2015 ACORD / \
<br /> ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD
<br /> 50272794 23/24 GL/AU/UMB/WC/POLL 1 Tina Wolter 15/30/2024 1:37.56 PM (PDT) Page 1 of 7
<br /> This cer ificate cancels and supersedes ALL previously issued certificates.
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