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DATE(MM/DD/YYYY)
<br /> "AC"I? CERTIFICATE OF LIABILITY INSURANCE
<br /> lk. � 1 07/15/2025
<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 endorsements.
<br /> PRODUCER CONTACT
<br /> NAME:
<br /> PHONE Chivaroli Premier Insurance Services IC,N Ext: 805 371-3680 FAX Ne: 805 371-3684
<br /> 200 North Westlake Blvd, Suite 101 ADDRESS: tristana chivaroli.com
<br /> Westlake Village, CA 91362 INSURER(S)AFFORDING COVERAGE NAIC#
<br /> INSURERA:Fidelity and Guaranty Insurance Company 35386
<br /> INSURED INSURER B:Travelers Property Casualty Company of America 25674
<br /> Regal Court Reporting, Inc. INSURERC:RLI Insurance Company 13056
<br /> 1551 N. Tustin Ave., Ste. 750 INSURERD:United Financial Casualty Co. 11770
<br /> Santa Ana, CA 92705 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 EFF POLICY EXP LIMITS
<br /> LTR I POLICY NUMBER MM/DD/YYYY MM/DD/YYYY
<br /> X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $2,000,000
<br /> A BIP-B3568697 05/15/2025 05/15/2026
<br /> DAMAGE TO RENTED
<br /> CLAIMS-MADE 1XI OCCUR PREMISE,(E.occurrence)
<br /> ccurrrence) $1,000,000
<br /> MED EXP(Any one person) $1 0,000
<br /> PERSONAL&ADV INJURY $2,000,000
<br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $4,000,000
<br /> X POLICY JECTT LOC PRODUCTS-COMP/OP AGG $4,000,000
<br /> OTHER: $
<br /> D Ea accident AUTOMOBILE LIABILITY 972889398 03/07/2025 09/07/2025 COMBINED SINGLE LIMIT $1,000,OOO
<br /> X ANY AUTO BODILY INJURY(Per person) $
<br /> OWNED X SCHEDULED BODILY INJURY(Per accident) $
<br /> AUTOS ONLY AUTOS
<br /> HIRED NON-OWNED PROPERTY DAMAGE $
<br /> AUTOS ONLY AUTOS ONLY Per accident
<br /> B X UMBRELLA LIAB OCCUR CUP-B356988A 05/15/2025 05/15/2026 EACH OCCURRENCE $5,000,000
<br /> EXCESS LIAB CLAIMS-MADE AGGREGATE $5,000,000
<br /> DED X RETENTION$0 Prods/Comp O s $5,000,000
<br /> WORKERS COMPENSATION PER OTH-
<br /> B AND EMPLOYERS'LIABILITY Y/N U B-B X 5034498 05/15/2025 05/15/2026 STATUTE ER
<br /> ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $1,000,000
<br /> OFFICER/MEMBER EXCLUDED? N/A
<br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000,000
<br /> Ifyes,describe under
<br /> DESCRIPTION OF OPERATIONS below I I I E.L.DISEASE-POLICY LIMIT $1,000,000
<br /> C Professional Liability RTP0045694 04/21/2025 04/21/2026 Occurrence 2,000,000
<br /> Aggregate 2,000,000
<br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
<br /> Evidence of Insurance Tu Tran TuTranNglly u) dby
<br /> Tu Tran N u en
<br /> Date:2025.0 .15
<br /> Nguyen 14:45:01-07' 0'
<br /> APPROVED
<br /> By Tu Tran Nguyen at 2:44 pm,Jul 15,2025
<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 /> y ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> Attn: HR Department
<br /> 20 Civic Center Plaza AUTHORIZED REPRESENTATIVE
<br /> Santa Ana, CA 92701
<br /> TAA
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<br /> ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD
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