LOENGREEN, INC. (COUNCIL CHAMBERS ADA RESTROOM AND TRANSLATION BOOTH REMODEL)

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, ACORD® CERTIFICATE OF LIABILITY INSURANCE °ATE`MM'°°'y'YY) Illito.....----- 9/19/2024 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 mktriir NAME: CAL-KOR Insurance Services PHONE(NC, 213)387-5000 FAX (213)388-8595 3255 Wilshire Blvd E MAILo,Ext): (NC,No): I ADDRESS: aY ita isy Angie NAIL# Ste 1500 I 1 U Q Los Angeles CA 90010 INSURER A: I I,edd Nato aalflnsu e Cor(ipany INSURED INSURER B: `eml•/ COI Loengreen Inc. INSURER C Scotts .`Insurance t I 2837JamesMW.Q'IvdC INSURER , C�;� ate:— . 9.25 09:46:52 -Q760C e O INS= — Rr.t E Los Angeles A 9 06 AS,rtER F: COVERAGES CERTIFICATE NUMBER: CL2462055573 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION 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 AUUL SUbIF POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INS° WVD POLICY NUMBER _f_MM/DDNYYY) (MM/DDIYYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE s 1,000,000 DAMAGE TO RENTED CLAIMS-MADE X OCCUR PREMISES(Ea occurrence) $ 50,000 MED EXP(Any one person) $ 5,000 A Y Y CSC0000696 01/14/2024 01/14/2025 PERSONAL&ADV INJURY $ 1,000,000 GEMLAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 3,000,000 PX POLICY JECT LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) ANY AUTO BODILY INJURY(Per person) $ B OWNED 5/ SCHEDULED Y Y 50007861301 09/11/2024 03/11/2025 BODILY INJURY(Per accident) $ AUTOS ONLY /� AUTOS X HIRED Nee NON-OWNED PROPERTY DAMAGE AUTOS ONLY /� AUTOS ONLY (Per accident) $ _ S X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 6,000,000 C EXCESS LIAB CLAIMS-MADE Y Y CXS4016706 01/14/2024 01/14/2025 AGGREGATE $ 6,000,000 DED RETENTION S $ WORKERS COMPENSATION X STATUTE EORH AND EMPLOYERS'LIABILITY Y/N D ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? Y N/A Y 92441452024 01/12/2024 01/12/2025 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS!LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) *10-day notice for non-payment of premium. The certificate holder is named as additional insured. The Commercial Umbrella/Excess Policy(#CXS4016706)underlies General Liability Policy(#CSC0000696)and Commercial Auto Policy(#50007861301) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE I THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN City of Santa Ana ACCORDANCE WITH THE POLICY PRO\I\ er- .o2• Risk Management Division 20 Civic Center Plaza N^f°�� REVIEWED&APPROVED BY: PO BOX 1988 AUTHORIZED REPRESENTATIVE t . � ' Av44 Santa Ana CA 92702 I �' Risk Management Specialist ©1988-2015 ACOF/ ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD