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CHAMGRO-01 RENAS
<br /> CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY)
<br /> 5/12/2025
<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 License#OM10410 CONTACT
<br /> NAME:
<br /> Armstrong/Robitaille/Riegle Business and Insurance Solutions PHONE FAX -9429
<br /> 18575 Jamboree Rd,Ste 500 (A/C,No,Ext): (949) 381-7700 No):(949) 861
<br /> Irvine,CA 92612-2545 a DDRIESS:arrinfo@aleragroup.com
<br /> INSURERS AFFORDING COVERAGE NAIC#
<br /> INSURERA:Nautilus Insurance Company 17370
<br /> INSURED INSURER B:Key Risk Insurance Company 10885
<br /> Chambers Group Inc. INSURERC:Hartford Underwriters Insurance Company 30104
<br /> 3151 Airway Ave,Suite F208 INSURER D:
<br /> Costa Mesa,CA 92626
<br /> INSURER E
<br /> 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 NUMBER POLICY EFF POLICY EXP LIMITS
<br /> LTR INSD WVD MWDD/YYYY MM/DD/YYYY
<br /> A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
<br /> CLAIMS-MADE DWI
<br /> X OCCUR ECP2026303-17 5/12/2025 5/12/2026 DAMAGE TO RENTED 100,000
<br /> X X PREMISES Ea occurrence $
<br /> X Ded:$1,000 MED EXP(Any oneperson) $ 10,000
<br /> PERSONAL&ADV INJURY $ 1,000,000
<br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000
<br /> POLICY X JECT1:1 LOC PRODUCTS-COMP/OPAGG $ 2,000,000
<br /> OTHER: POLLUTION PROFE $ 1,000,000
<br /> B AUTOMOBILE LIABILITY CMBINED SINGLE LIMIT 1,000,000
<br /> EaO accident $
<br /> X ANY AUTO BAP2037737-13 5/12/2025 5/12/2026 BODILY INJURY Perperson) $
<br /> OWNED SCHEDULED
<br /> AUTOS ONLY AUTOS BODILY INJURY Per accident $
<br /> X HIRED X NON-OWNED PROPERTY DAMAGE
<br /> AUTOS ONLY AUTOS ONLY Per accident $
<br /> A UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 10,000,000
<br /> X EXCESS LIAB CLAIMS-MADE FFX2026322-17 5/12/2025 5/12/2026 AGGREGATE $ 10,000,000
<br /> DED RETENTION$ $
<br /> C WORKERS COMPENSATION X PER OTH-
<br /> AND EMPLOYERS'LIABILITY STATUTE ER
<br /> Y/N 72WECBR4W3D 5/12/2025 5/12/2026 1,000,000
<br /> ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ E.L.EACH ACCIDENT $
<br /> OFFICER/MEMBER EXCLUDED? N/A
<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 /> A Pollution Liability ECP2026303-17 5/12/2025 5/12/2026 Limit 1,000,000
<br /> A Professional Liab. ECP2026303-17 5/12/2025 5/12/2026 Limit 1,000,000
<br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
<br /> City of Santa Ana,officers,agents,employees,and volunteers are included as additional insured per the attached form. Waiver of Subrogation applies to the
<br /> General Liability policy per the attached form. Primary/Non-Contributory wording applies to the General Liability policy per the attached form.30 Day Notice
<br /> of Cancellation with the exception of 10 days for non-payment of premium.
<br /> Tu Tran Digitally signed by
<br /> Tu Tran Nguyen APPROVED
<br /> Nguyen Date:2025.06.09 By Tu Tran Nguyen at 9:31 am,Jun 09,2025
<br /> 09:32:23-07'00'
<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 /> ty ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> Planning and Building Agency
<br /> 20 Civic Center Plaza
<br /> Santa Ana,CA 92701 AUTHORIZED REPRESENTATIVE
<br /> ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved.
<br /> The ACORD name and logo are registered marks of ACORD
<br />
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