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DATE(MM/DD/YYYY)
<br /> A�" CERTIFICATE OF LIABILITY INSURANCE
<br /> 08/04/2025
<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 REP Stephen Roth
<br /> NAME:
<br /> Corona Insurance Agency PHONE FAX
<br /> A/C No Ext: A/C,No):
<br /> 355 Rincon,Suite 105 E-MAIL sroth@pcfoy.com
<br /> ADDRESS:
<br /> INSURER(S)AFFORDING COVERAGE NAIC#
<br /> Corona CA 92879 INSURERA: Philadelphia Indemnity Insurance Company 18058
<br /> INSURED INSURER B: Cypress Insurance Company 10855
<br /> OCSA INSURER C:
<br /> 1010 N.Main Street INSURER D:
<br /> INSURER E:
<br /> Santa Ana CA 92701 INSURER F:
<br /> COVERAGES CERTIFICATE NUMBER: 25-26 MASTER 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
<br /> CERTIFICATE MAYBE 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 POLICY EFF POLICY EXP
<br /> LTR INSD WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS
<br /> X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
<br /> CLAIMS-MADE FX OCCUR PREM SDAMAGES Ea oNcurDrence $ 100'000
<br /> MED EXP(Any one person) $ 5,000
<br /> A Y Y PHPK2571348-023 07/01/2025 07/01/2026 PERSONAL&ADV INJURY $ 1,000,000
<br /> MOTHER
<br /> LAGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $ 3,000,000
<br /> POLICY ❑ PRO ❑ LOC PRODUCTS-COMP/OPAGG $ 1,000,000
<br /> JECT: ABUSE& $ 1,000,000
<br /> AUTOMOBILE LIABILITY 00MEWEDSIN6L€LIMIT $ 1,000,000
<br /> Ea accident
<br /> X ANYAUTO BODILY INJURY(Per person) $
<br /> A OWNED SCHEDULED PHPK2571348-023 07/01/2025 07/01/2026 BODI LY I NJ U RY(Pe r accide nt) $
<br /> AUTOS ONLY AUTOS
<br /> HIRED NON-OWNED PROPERTY DAMAGE $
<br /> AUTOS ONLY AUTOS ONLY Per accident
<br /> Medical payments $ 5,000
<br /> UMBRELLA LIAB OCCUR EACH OCCURRENCE $
<br /> EXCESS LAB CLAIMS-MADE AGGREGATE $
<br /> DED I I RETENTION $ $
<br /> WORKERS COMPENSATION ER/� STATUTE EORH
<br /> AND EMPLOYERS'LIABI LI TY YIN 1,000,000
<br /> ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $
<br /> B OFFICER/MEMBER EXCLUDED? N/A ORWC613376 07/01/2025 07/01/2026
<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 /> Abusive Conuct Liability Aggregate $2,000,000
<br /> A PHPK2571348-023 07/01/2025 07/01/2026 Ea Abusive Conduct $1,000,000
<br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
<br /> [Job#: Job Type:RE:USE OF 1 OTH ST.]
<br /> THE CITY,ITS OFFICERS,OFFICIALS,EMPLOYEES,AGENTS,AND VOLUNTEERS ARE NAMED AS ADDITIONAL INSURED PER THE ATTACHED
<br /> PL-GLD-VS(05/17)INCLUDES PRIMARY&WAIVER.
<br /> Tu Tran T�T,an Nguye by
<br /> Nguyeno8z444-0700' APPROVED
<br /> By Tu Tran Nguyen at 8:24 am,Sep 02,2025
<br /> CERTIFICATE HOLDER CANCELLATION
<br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN
<br /> City of Santa Ana ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> 20 Civic Center Plaza
<br /> AUTHORIZED REPRESENTATIVE
<br /> Santa Ana CA 92701
<br /> @ 1988-2015 ACORD CORPORATION. All rights reserved.
<br /> ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD
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