MLANDEN BUNTICH CONSTRUCTION CO., INC. (2)

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CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDNYYY) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Venbrook Insurance Services Venbrook Insurance Services PHONE 811i 9B B FAL No: BIB-59B-891O Woodland Hills, CA 6320 Canoga Avenue 12th Floor r� _ E-MAI �67_ � � � _ ADDR sfi: Pni x� INSURED INSUA FT:/rt{sBf�laMVF'yuflkpQpq�, y �UI Mladen Buntich Construction Co., Nsr .ER c Starr "Ie nily &Liability Co_ V 1500 W. 9th Street Upland CA91786 —1 INrIRERD:I neeil�Ie3i'llencEfO%u� 06 A A I A !Y 1' FIIR�(W� L n r s COVERAGES / -1 f \ e /1 / . JtpdnmduluJRAiI if A r THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BEI JVN' HAVE BEEN ISS E 0 T INS NAME VE HE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR COND. rION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL SUBR Am POLICYNUMBER POLICY EFF MWUD POLICY UP MWDD LIMITS A r/ COMMERCIAL GENERAL LIABILITY CLAIMS -MADE �✓ OCCUR BFPO/XCU/OCP ✓ 54303218 Deductible: $10,000 9/26/2023 9/26/2024 EACH OCCURRENCE $1000000 WAMAGE TO -RENTED PREMISES (Ea occurrence) $100000 ✓ MEO UP (Any one person) $S OOO ✓ Contractual PERSONAL &ADV INJURY $1000000 GEN'L AGGREGATE LIMIT APPLIES PER POLICY 0 JECT 7 LOG GENERALAGGREGATE $2,000,000 PRODUCTS -COMPIOPAGG $2000000 $ OTHER: B AUTOMOBILE LIABILITY 54303217 9/26/2023 9/26/2024 INGLE LIMIT EeEOccuren�/Ag!gmgat $1 Q00 O00 ANY AUTO OWNED SCHFOULED AUTOS ONLY AUTOS HIRED NON'WNED AUTOS ONLY ✓ AUTOS ONLY Physical Damage for Hired &Non -Owned $50,000/$5,000 Ded BOINJURY person) $ BORY (Par accident) $ ✓ PRDAMAGE P $ $ Core 5 000 ✓ Coll: 5 000 C �/ UMBRELLALIAB OCCUR 1000586574231 9/26/2023 9/26/2024 EARRENCE $5000000 ✓ AGE $$QQQ QQQ D EXCESS LIAR CIAIMS-MADE (underlying GL, AL, EL) CXP-022252-00 (overStarr) 9/26/2023 9/26/2024 DEO RETENTION $ Eance/ AggrTH- g5000000 B WORKERS COMPENSATION ANDEMPLOYERS' LU\BILITY YIN ANYPROPRIETORIPARTNERIEXECUTIVE OFFICERIMEMBEREXCLUDEDV � NIA 54303219 9/26/2023 9/26/2024 PER OTH- ✓ I STATUTE ER F.L. EACH ACCIDENT $1 000000 E.L. DISEASE - EA EMPLOYEE $1 000,000 (Mandatary In NH) If yes, describe under E.L. DISEASE -POLICY LIMIT $1000000 DESCRIPTION OF OPERATIONS below E Inland Marine/Equipment SML93044881 9/26/2023 9/26/2024 $13,387,094 / $1,000 Deductible E Leased/Rented SML93044881 9/26/2023 9/26/2024 $1,000,000 / $5,000 Deductible E Installation Floater SML93044881 9/26/2023 9/26/2024 $3,500,000 / $1,000 Deductible F Contractors Pollution Liability iabilit G71182393 006 9/26/2023 9/26/2024 $5,000,000 / $5 000 000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) RE: Extension Agreement (A-2021-132-02) for Sewer System Repair Services Certificate holder is named as Additional Insured's under the General Liability policy if required by written contract with the Named Insured but only for coverages and limits provided by the policy and the additional insured endorsement. *10 Days Notice of Cancellation for Non -Payment of Premium, 30 Days All Others. City of Santa Ana Public Works Agency P.O. Box 1988 20 Civic Center Plaza Santa Ana CA 92702 AUTHORIZEDREPRESENTATIVE it 01988-2015 ACORD ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD 60545334 1 23-24 cL AL EX WC Cro Per, I Adrienne Padilla 1 6/19/2024 10:52:49 AN (PUT) I Page 1 of 2 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF- NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PRC RA M®MgemelltDIP[slmt olmlri-u-4 REVIEWED&APPROVED BY: A+.f.a Aurwcd Risk Management Specialist