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A`ORD CERTIFICATE OF LIABILITY INSURANCE DAT7/z3/ZDIY)
<br /> 024
<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 CONTAC-
<br /> Burnham WGB Insur. e Solutions NAME: KilSt erez • a Q •
<br /> PHONE
<br /> CA Insurance Licens A697 1 • E-MA L ''c'7 i 9 I t o I I s Ta 1 t e�1
<br /> 15901 Red Hill Ave ADORES: _K is en.pere n. gbi com
<br /> Tustin CA 92780 INSURER(S)`a FFORDING COVERAGE NAIC#
<br /> INSURER E F anc:/,rrS',j'j die
<br /> • ,a, gCeved o
<br /> INSURED AJFIS-1 INSURE)" 3: Inn F anc':I r
<br /> A.J.Fistes Corporation
<br /> 1244 N.Gaffey Street INSUR' :C:E -rest National Insurance Corn 10120
<br /> San Pedro CA 90731 INSU I ERE. Gr 3 'G .nc
<br /> i IIAI : F: ` L�
<br /> COVERAGES C: 'TIFICA 'ER:47 fl al al RE 0. NUM: :
<br /> THIS IS TO CERTI THAT E - IE SU'. NCE . B- .V- ISSU .e , UR D • • :OKG ' T•E -•V i l RIOD
<br /> INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR COt )IT' ,N OF ANY CONT • .R I R DOC. ITH -P CT T,. . THIS
<br /> CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AF'JRDED 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 LTR TYPE OF INSURANCE ADDL INSD SUBR WVD POLICY NUMBER POLICY EFF POLICY EXP LIMITS
<br /> (MMIDD/YYYY) (MMIDDIYYYYI
<br /> C X COMMERCIAL GENERAL LIABILITY Y CF1GL00279241 4/19/2024 4/19/2025 EACH OCCURRENCE $1,000,000
<br /> CLAIMS-MADE X OCCUR DAMAGE TO RENTED
<br /> PREMISES(Ea occurrence) S 100,000
<br /> MED EXP(Any one person) S 5,000
<br /> PERSONAL&ADV INJURY $1,000,000
<br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000
<br /> POLICY X JECT LOC
<br /> PRODUCTS-COMP/OP AGO $2,000,000
<br /> OTHER: $
<br /> B AUTOMOBILE LIABILITY Y 975530280 6/8/2024 12/8/2024 COMBINED SINGLE LIMIT $1,000,000
<br /> (Ea accident)
<br /> ANY AUTO BODILY INJURY(Per person) $
<br /> - OWNED X SCHEDULED BODILY INJURY(Per accident) $
<br /> AUTOS ONLY _ AUTOS
<br /> Xr HIRED NON-OWNED PROPERTY DAMAGE $
<br /> AUTOS ONLY AUTOS ONLY (Per accident)
<br /> $
<br /> D UMBRELLA LIAB X OCCUR EXC5201094 4/19/2024 4/19/2025 EACH OCCURRENCE $5,000,000 _
<br /> X EXCESS LIAB CLAIMS-MADE AGGREGATE $5,000,000
<br /> DED RETENTION$ $
<br /> A WORKERS COMPENSATION Y 7600023383241 6/30/2024 6/30/2025 X PER OTH-
<br /> AND EMPLOYERS'LIABILITY YINri STATUTE ER
<br /> ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $1,000,000
<br /> OFFICER/MEMBER EXCLUDED? N I A
<br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE S 1,000,000
<br /> If yes,describe under
<br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S 1,000,000
<br /> DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
<br /> RE:Agreement Nos.A-2017-172 and A-2017-290,SARTC Painting
<br /> The City of Santa Ana,its officers,employees,agents,and representatives are included as Additional Insured with respect to General and Auto Liability if
<br /> required by written contract and subject to terms,conditions and exclusions of the policy.Coverage is provided on a Primary&Non-Contributory basis on
<br /> General and Auto Liability if required by written contract and subject to terms,conditions and exclusions of the policy.A Waiver of Subrogation in favor of The
<br /> City of Santa Ana,its officers,employees,agents,and representatives applies to Workers Compensation if required by written contract,and subject to terms,
<br /> conditions,and exclusions of the policy.30-day notice of cancellation,except for nonpayment of premium.
<br /> CERTIFICATE HOLDER CANCELLATION
<br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE I
<br /> THE EXPIRATION DATE THEREOF. NOTICE WILL BE DELIVERED IN
<br /> City of Santa Ana ACCORDANCE WITH THE POLICY PRC\ '
<br /> RbltManagementDivialon 1 Risk Management Division �9
<br /> 20 Civic Center Plaza AUTHORIZED REPRESENTATIVE z;' 1. REVIEWED&APPROVED BY:
<br /> Santa Ana CA 92702 —� -. °!A 111 i c� A Aug
<br /> '
<br /> I CM' Risk Management Specialist Ti-
<br /> ...,
<br /> ©1988-2015 ACORD /
<br /> ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD
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