|
DATE(MM/DD/YYYY)
<br /> AC"I?" CERTIFICATE OF LIABILITY INSURANCE
<br /> kl%. � 1 04/07/2025
<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 NAME: Michael Greenwood
<br /> Michael Scott Greenwood A/CN No,EXt: 714-744-4119 FAX No): 714-744 4255
<br /> 17853 Santiago Blvd Ste 107-233 ADDRESS: g E-MAIL mscottreenwood@g mail.com
<br /> INSURER(S)AFFORDING COVERAGE NAIC#
<br /> Villa Park CA 92861 INSURERA: Incline Casualty Ins Comp 11090
<br /> INSURED INSURER B: Lloyds of London
<br /> Elite Executive Charter, LLC. INSURERC: Siriuspoint America Insurance Company 38776
<br /> 13281 Eton Place INSURER D:
<br /> INSURER E:
<br /> Cowan Heights CA 92705 INSURER F:
<br /> COVERAGES CERTIFICATE NUMBER: 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 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 SUBR POLICY EFF POLICY EXP LIMITS
<br /> LTR I POLICY NUMBER MM/DD/YYYY MM/DDIYYYY
<br /> A X COMMERCIAL GENERAL LIABILITY X 5ST11201-02 01/24/2025 01/24/2026 EACH OCCURRENCE $ 2,000,000
<br /> F;vil DAMAGE TO RENTED
<br /> CLAIMS-MADE OCCUR PREMISES Ea occurrence $ 100,000
<br /> MED EXP(Any one person) $ 5,000
<br /> PERSONAL&ADV INJURY $ 2,000,000
<br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 4,000,000
<br /> POLICY PRO LOC PRODUCTS-COMP/OP AGG $ 4,000,000
<br /> JECT
<br /> OTHER:El $
<br /> A AUTOMOBILE LIABILITY X 5ST11201-02 01/24/2025 01/24/2026 COMBINED SINGLE LIMIT $ 2,000,000
<br /> Ea accident
<br /> ANY AUTO BODILY INJURY(Per person) $
<br /> OWNED SCHEDULED BODILY INJURY(Per accident) $
<br /> AUTOS ONLY AUTOS
<br /> XHIRED NON-OWNED PROPERTY DAMAGE $
<br /> AUTOS ONLY /� AUTOS ONLY Per accident
<br /> A UMBRELLALIAB X OCCUR X 5ST11201-02 01/24/2025 01/24/2026 EACH OCCURRENCE $ 3,000,000
<br /> X EXCESS LIAB CLAIMS-MADE AGGREGATE $
<br /> DED RETENTION$ $
<br /> C WORKERS COMPENSATION WC PI 813008-001 02/23/2025 02/213/2026 X PER OTH-
<br /> AND EMPLOYERS'LIABILITY YIN STATUTE ER
<br /> ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000
<br /> OFFICER/MEMBER EXCLUDED? Fy] NIA
<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 /> B Sexual Abuse&Molestation X W35OBF240201 06/01/2024 06/01/2025 Each Victim $1,000,000
<br /> A Comp&Coll 5ST11201-02 01/24/2025 01/24/2026 Less$2,500 Ded
<br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
<br /> a•oeCity of Santa Ana, its City Council, officers, officials, employees, agents, and volunteers.a•s are to be
<br /> named as additional insured, auto liability, general liability and SAM policies.
<br /> Coverage Includes: Waiver of Subrogation and Primary and non contributory applies to all policies.
<br /> Digitally signed
<br /> Tu Tran by Tu Trzn
<br /> Dgte:2 APPROVE®
<br /> Nguyen Dzte:2�25.�5.�,
<br /> 1e,Le4,,dApp. eb�d 1359:07-0700. gy Tu Tran Nguyen at 1:58 pm,May01,2025
<br /> CERTIFICATE HOLDER CANCELLATION
<br /> City of Santa Ana SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> 20 Civic Center Plaza, M23 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br /> Santa Ana, CA. 92701 ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> AUTHORIZED REPRESENTATIVE
<br /> ©1988-2015 ACORD CORPORATION. All rights reserved.
<br /> ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD
<br />
|