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ACORD DATE /DD/YYYY)
<br /> TE(MM
<br /> CERTIFICATE OF LIABILITY INSURANCE TE(MM/2026
<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 /> NAME: Michael Greenwood
<br /> FAX
<br /> HONE Michael Scott Greenwood A/CC No Ext: 714-744-4119 c 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 INSURERB: Beazley Excess and Surplus Insurance, Inc. 17520
<br /> Elite Executive Charter, LLC. INSURERC: Siriuspoint America Insurance Company 38776
<br /> 13281 Eton Place INSURER D: Swiss Re Corporate Solutions Capacity 29874
<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 INDICATED.
<br /> NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE
<br /> ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF
<br /> SUCH POLICIES. *LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LIMITS SHOWN ARE INCLUSIVE OF AMOUNTS REQUESTED BY THE CERTIFICATE
<br /> HOLDER AND MAY NOT REFLECT POLICY LIMIT AMOUNTS IN EXCESS OF THOSE REQUESTED. *Not Applicable in WY
<br /> INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS
<br /> LTR INSD WVD POLICYNUMBER MM/DD/YYYY MM/DD/YYYY
<br /> A X COMMERCIAL GENERAL LIABILITY X X 5ST11201-03 01/24/2026 01/24/2027 EACH OCCURRENCE $ 2,000,000
<br /> DAMAGE TO RENTED
<br /> CLAIMS-MADE � OCCUR PREMISES
<br /> (E.occurrence)
<br /> ccurrrence) $ 100,000
<br /> MED EXP(Any one person) $ 5,000
<br /> PERSONAL&ADV INJURY $ 2,000,000
<br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE $ 4,000,000
<br /> POLICY❑ PRO-
<br /> ❑
<br /> JECT LOC PRODUCTS-COMP/OPAGG $ 4,000,000
<br /> OTHER: $
<br /> A AUTOMOBILE LIABILITY X X 5ST11201-03 01/24/2025 01/24/2027 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 PROPcciERTY DAMAGE $
<br /> AUTOS ONLY /� AUTOS ONLY Per adent
<br /> A UMBRELLA LAB X OCCUR X X 5ST11201-03 01/24/2025 01/24/2027 EACH OCCURRENCE $ 3,000,000
<br /> X EXCESS LAB CLAIMS-MADE AGGREGATE $
<br /> DED RETENTION$ $
<br /> C WORKERS COMPENSATION WC PI 813008-001 02/23/2025 02/23/2027 X PER OTH-
<br /> AND EMPLOYERS'LIABILITY Y/N STATUTE ER
<br /> ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000
<br /> OFFICER/MEMBER EXCLUDED? FY] N/A
<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 X D350BF250301 06/01/2025 06/01/2026 Each Victim $1,000,000
<br /> A Comp&Coll 5ST11201-03 01/24/2026 01/24/2027
<br /> C Excess ELX6300642-00 02/04/2026 01/24/2027 Less$2,500 Ded
<br /> Per Occurrence $1,000,000
<br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached if more space is required)
<br /> City of Santa Ana, its City Council, officers, officials, employees, agents, and volunteers.A¢a•¢Ai 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 /> CERTIFICATE HOLDER CANCELLATION APPROVED
<br /> By Tu Tran Nguyen at 2:20 pm,May 29,2026
<br /> City of Santa Ana, Attention: Parks, SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> Recreation, and Community Services THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br /> Agency ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> 20 Civic Center Plaza, CA 92701, M-23 AUTHORIZED REPRESENTATIVE
<br /> Santa Ana, CA 92701 110,7
<br /> ACORD 25(2025/12) ©1988-2025 ACORD CORPORATION. All rights reserved.
<br /> The ACORD name and logo are registered marks of ACORD
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