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AC ORE)® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY)
<br /> L------ 7/1/2024 _
<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 ,., j-� h IOA Insurance Service a NAME: Vng �t I I y S'y n a `q' 7 d e
<br /> ie PHONE
<br /> 130 Vantis (NC.No.I r c o 4 -
<br /> E-MAIL
<br /> Suite 250 E-MAILADDRESS: Ch I.Perkovich i ausa.com
<br /> Aliso Viejo CA 92656 _ ( NGCOVERAGE NAIC#
<br /> License#:0E67768 INSUREF A:T lers Prope ItJ��(�j C ny f e'c 2 7
<br /> INSURED DUTHELE-01 INSUR'.RB:crL/ te:r i irl[Sy�i nyl I *074
<br /> 2335Duthie E.
<br /> Cherrryc Indust p :evedo
<br /> Che Indust e INSI'.<ERC:Houston, su:iItvCompany p y 42374
<br /> LongBeach CA 9080 �f URER D:The el emnitycompany of Connecticut 25682
<br /> INSURER E:Travelers Property Casualty Insurance Company 36161
<br /> INSURER F:At-Bay Specialty Insurance Company 19607 -
<br /> COVERAGES CERTIFICATE NUMBER:655371844 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 ADDL SUBR POLICY EFF POLICY EXP
<br /> LTR TYPE OF INSURANCE INSD,VVD POLICY NUMBER 1MM/DD/YYYY)_(MMIDD!YYYY1_ LIMITS
<br /> A X COMMERCIAL GENERAL LIABILITY Y Y Y-630-2A626927-TIL-24 7/1/2024 7/1/2025 EACH OCCURRENCE $1,000,000
<br /> CLAIMS-MADE X OCCUR DAMAGE TO RENTED
<br /> PREMISES(Ea occurrence) $300,000
<br /> MED EXP(Any one person) $5,000
<br /> PERSONAL&ADV INJURY $1,000,000 _
<br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000
<br /> POLICY X JET LOC PRODUCTS-COMP/OP AGG $2,000,000
<br /> OTHER: Deductible $0
<br /> D AUTOMOBILE LIABILITY Y Y 810-2N338740-24-14-G 7/1/2024 7/1/2025 (Ea it accideIUINGLE LIMIT $1,000,000
<br /> X ANY AUTO BODILY INJURY(Per person) $
<br /> OWNED SCHEDULED (Per
<br /> BODILY INJURY $
<br /> AUTOS ONLY AUTOS accident)
<br /> x HIRED X NON-OWNED PROPERTY DAMAGE
<br /> AUTOS ONLY AUTOS ONLY (Per accident) $
<br /> E X UMBRELLA LIAB X OCCUR Y Y CUP-3S17641A-24-NF 7/1/2024 7/1/2025 EACH OCCURRENCE $15,000,000
<br /> EXCESS LIAB CLAIMS-MADE AGGREGATE $15,000,000
<br /> DED X RETENTION$1nJ)nn $
<br /> A WORKERS COMPENSATION Y UB-7K475503-24-14-G 7/1/2024 7/1/2025 X STATUTE ERH
<br /> AND EMPLOYERS'LIABILITY Y/N
<br /> ANYPROPRIETORIPARTNER/EXECUTIVE E.L.EACH ACCIDENT $1,000,000
<br /> OFFICER/MEMBER EXCLUDED? NIA
<br /> (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $1,000,000
<br /> If yes,describe under
<br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000
<br /> B Contractors Pollution PKC115513 7/1/2024 7/1/2025 Occurence/Aggregate $3,000,000
<br /> C Contractors Professional HCC2471053 7/1/2024 7/1/2025 Each Claim/Aggregate $1,000,000
<br /> F Cyber Liability AB-6608105-04 7/1/2024 7/1/2025 Each Claim/Aggregate $2,000,000
<br /> DESCRIPTION OF OPERATIONS!LOCATIONS!VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required)
<br /> *Contractors Pollution-$10,000 Deductible
<br /> *Contractors Professional(Claims Made)-$10,000 Each Claim Deductible
<br /> The certificate holder(s)is/are included as an additional insured(s)with respects to General Liability for Ongoing and Completed Operations and Auto Liability
<br /> (per forms CG D6 04 02 19,CG D4 58 02 19 and CA T3 53 02 15);General Liability and Auto Liability are Primary and Non-Contributory(per forms CG T1 00
<br /> 02 19 and CA 00 01 10 13);Waiver of Subrogation applies to General Liability,Auto Liability and Workers Compensation(per forms CG D4 58 02 19,CA T3 53
<br /> 02 15 and WC 99 03 76);Additional Insured and Waiver of Subrogation applies to Umbrella Liability;Umbrella Liability follows form.Per Project Aggregate
<br /> Endorsement policy form CG D3 21 01 04 is provided as required by a written contract;All coverage is only applicable as required by written contract.
<br /> See Attached...
<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 PRC\ /
<br /> Risk Management Division .. Risk Man>agentaliDvision
<br /> 20 Civic Center Plaza,4th floor AUT ORIZED REPRESENTATIVE g REVIEWED&APPROVED BY:
<br /> Santa Ana CA 92701 .. � AtiZt ALAVA
<br /> I '�— '��� Risk Management Specialist
<br /> ©1988-2015 ACORD/
<br /> ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD
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