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DATE(MM/DD/YYYY)
<br /> A` "� CERTIFICATE OF LIABILITY INSURANCE 8/26/2024
<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 /> NAME: Annl Owens
<br /> AssuredPartners Design Profe ionals Insurance Services, LLC PHONE —
<br /> 3697 Mt. Diablo Blvd Suite 23 A/c No Ext: 1 0-2 2-
<br /> Lafayette CA 94549 ie
<br /> ADDRI rESS: Ce,r<Design Assured cow I
<br /> IN RERS)AFPORDING FVVERAGE NAIC#
<br /> Anq
<br /> License#:6003745-INSURER A: BFn< 32603
<br /> INSURED MIGINCO-01 MIG, Inc. INSURER B:T aye, rs Property Casualty Company of America 25674
<br /> Moore lacofano Goltsman, IAceved (AURE..E:
<br /> INSURER C- i-he Tr v` 19. ti teF ity a C n is t 25682
<br /> 800 Hearst Ave URER r ; 111-0 A.1 11..�L..• •
<br /> Berkeley CA 94710 1 1
<br /> I'SU'.ER F: • •
<br /> COVERAGES CERTIFICATE NUMBER:1921223621 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 /> C X COMMERCIAL GENERAL LIABILITY Y Y 6801 H899998 8/31/2024 8/31/2025 EACH OCCURRENCE $1,000,000
<br /> DAMAGE TO RENTED
<br /> CLAIMS-MADE OCCUR
<br /> PREMISES Ea occurrence $1,000,000
<br /> X Contractual Liab MED EXP(Any one person) $10,000
<br /> Included PERSONAL&ADV INJURY $1,000,000
<br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000
<br /> PRO-
<br /> POLICY� ECT1:1 LOC PRODUCTS-COMP/OP AGG $2,000,000
<br /> OTHER: $
<br /> C AUTOMOBILE LIABILITY Y Y BADS579947 8/31/2024 8/31/2025 COMBINED SINGLE LIMIT $1,000,000
<br /> Ea accident
<br /> X ANY AUTO BODILY INJURY(Per person) $
<br /> OWNED SCHEDULED BODILY INJURY(Per accident) $
<br /> AUTOS ONLY AUTOS
<br /> X HIRED X NON-OWNED PROPERTY DAMAGE $
<br /> AUTOS ONLY AUTOS ONLY Per accident
<br /> B X UMBRELLALIAB X OCCUR Y Y CUPOH758762 8/31/2024 8/31/2025 EACH OCCURRENCE $10,000,000
<br /> EXCESS LIAB CLAIMS-MADE AGGREGATE $10,000,000
<br /> DED X RETENTION$n $
<br /> B WORKERS COMPENSATION Y U1321-553909 8/31/2024 8/31/2025 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? 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 /> A Professional Liability& AEC907002005 8/31/2023 10/31/2024 Per Claim/5,000,000 $5,000,000/Aggr
<br /> Contr.Pollution Liab Included Included
<br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
<br /> The Umbrella Policy is follow form to its underlying Policies:General Liability/Auto Liability/Employers Liability.
<br /> RFP No.23-010. Project:California Environmental Quality Act(CEQA).
<br /> City of Santa Ana,its officers,officials,employees,and volunteers are named as an additional insured as respects general liability and auto liability as required
<br /> per written contract. General Liability is Primary/Non-Contributory per policy form wording.Insurance coverage includes waiver of subrogation per the attached
<br /> endorsement(s).
<br /> CERTIFICATE HOLDER CANCELLATION 30 Day Notice of Cancellation
<br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> THE EXPIRATION DATE THEREOF. NOTICE WILL FIF DELIVERED IN
<br /> City of Santa Ana ACCORDANCE WITH THE POLICY PRC
<br /> 20 Civic Center Plaza(M-30) R[eleManagementDmsinrt
<br /> P.O. Box 1988 AUTHORIZED REPRESENTATIVE REVIEWED&APPROVED BY:
<br /> Santa Ana CA 92702-1988 � gi e Aecv44
<br /> �� Risk Management Specialist
<br /> ©1988-2015 ACORD
<br /> ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD
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