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AC- ® DATE)MM/DD/YYYY)
<br /> CERTIFICATE OF LIABILITY INSURANCE 09/13/2023 N
<br /> THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS p
<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. co
<br /> IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed.If
<br /> SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this 2
<br /> certificate does not confer rights to the certificate holder in lieu of such endorseme Itts).,^`•^ • • 'T.
<br /> PRODUCER • e CONTACT L.� !gadfly
<br /> Q r�d f i v signed
<br /> I a n e d t/ i
<br /> Los Insurance Servi WeS�C. i
<br /> PHONE 1 -IJ�/ _J Y
<br /> Los Angeles CA Office (A C.Na.Ext): ,866) 283- FAX
<br /> No.): 0) 363-0105 `y
<br /> 707 Wilshire Boulevard E-MAIL -0Sui geeADDRESS: vedoS
<br /> Loss Angelles CA 90017-0460 u5A
<br /> Argjcc?G NAIC#
<br /> INSURED INSURER S fasty,I�nsuran C (/1■ r}G,3
<br /> ACCO Engineered Systems, INSUREr a: Li t-e Fir�1"5 24.•0rl D
<br /> 888 East walnut Street ` a J . VVV
<br /> Pasadena CA 91101 USA C e v e LM Insuran,.. ''nrporation 33600
<br /> e.
<br /> I r SURER E: Ae I C71 a CCa9,462
<br /> 5�d1 !yc o 7'0 066
<br /> I INSURER F: ��V✓✓
<br /> COVERAGES CERTIFICATE NUMBER: 570101483879 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. Limits shown are as requested
<br /> IN SUSII POLICY EFF POLICY EXP
<br /> LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD/YYYY1 IMM1DD/YYYY) LIMITS
<br /> B X COMMERCIAL GENERAL LIABILITY Y Y TB2661067353033 10/01/2023 10/01/2024 EACH OCCURRENCE $2,000,000
<br /> DAMAGE TO RENTED
<br /> CLAIMS-MADE X OCCUR $1,000,000PREMISES(Ea occurrence)
<br /> MED EXP(Any one person) 15,000
<br /> PERSONALS ADV INJURY $2,000,000 ,92
<br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $4,000,000 m
<br /> POLICY X PRO X LOC d'
<br /> JECT PRODUCTS.COMP/OP AGG $4,000,000
<br /> 0
<br /> OTHER:
<br /> N-
<br /> N-
<br /> B AUTOMOBILE LIABILITY Y Y AS2-661-067353-023 10/01/2023 10/01/2024 COMBINED SINGLE LIMIT $5,000,000
<br /> (Ea accident)
<br /> X ANY AUTO BODILY INJURY(Per person) 0
<br /> OWNED SCHEDULED BODILY INJURY(Per accidenl) rU
<br /> AUTOS
<br /> HIRED TO AUOTOS NON-OWNED NLY PROPERTY DAMAGE RI
<br /> ONLY _AUTOS ONLY (Per accident) F
<br /> E UMBRELLALIAB X OCCUR Y Y EUA2463708502 10/01/2023 10/01/2024 EACH OCCURRENCE $5,000,000 e
<br /> X EXCESS LIAR CLAIMS-MADE AGGREGATE 15,000,000
<br /> DED RETENTION
<br /> C WORKERS COMPENSATION AND Y WA566D067353013 10/01/2023 10/01/2024 x PER STATUTE OTH-
<br /> EMPLOYERS'LIABILITY y/N ER
<br /> ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $1,000,000
<br /> OFFICER/MEMBER EXCLUDED? N N/A
<br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000,000
<br /> II yes,describe under
<br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000—
<br /> D Environmental Contractors and Y PCADB50232041023 10/01/2023 10/01/2024 Aggregate/Each Loss $2,000,000
<br /> Prof Claims Made Prof Agg SIR $600,000—
<br /> SIR applies per policy terns & condi- '
<br /> ions Prof Each Claim SIR $200,000
<br /> DESCRIPTION OF OPERATIONS!LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
<br /> [RE: Construction, All Operations.]
<br /> [AI: City of Santa Ana, its officers, employees, agents and representatives] are included as Additional Insured with respect
<br /> . to the General Liability and Automobile Liability Policies; granted a Waiver of Subrogation for the General Liability,
<br /> Automobile Liability, Professional Liability and Workers' Compensation Policies; and General Liability Policy evidenced herein
<br /> is Primary and Non-Contributory to other insurance available as required by written contract but limited to the operations of
<br /> the insured under the said contract. Excess Liability is Follow Form.
<br /> N,
<br /> CERTIFICATE HOLDER CANCELLATION
<br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE ra
<br /> EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE
<br /> POLICY PROVISIONS.
<br /> ec.City of Santa Ana AUTHORIZED REPRESENTATIVE —/
<br /> Attn: Risk Management Division
<br /> 20 Civic Center Plaza, 4th Floor datampg e �� y
<br /> Santa Ana CA 92701 USA gr,.1 3"� REVIEWED&APPROVEDBr:
<br /> /a
<br /> Azusa
<br /> Risk Management Specialist
<br /> ©1988-2015 ACORD CC,
<br /> ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD
<br />
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