|
CERTIFICATE OF LIABILITY INSURANCE F DATE(MM/DD/YYYY)
<br /> nco�tn
<br /> 12/02/2025
<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 endorsement(s).
<br /> PRODUCER CONTACT
<br /> NAME: John Boughton
<br /> San Tan Insurance PHONE rxt).480-391-3883 a/c No:480-391-9484
<br /> 625 N Gilbert Rd.,Suite 107 E-MAIL JFBoughton@santaninsurance.net
<br /> INSURERS AFFORDING COVERAGE NAIC#
<br /> Gilbert AZ 85234 INSURER A: Hartford Casualty Insurance Co
<br /> INSURED
<br /> INSURER B
<br /> IK Consulting, LLC INSURER C:
<br /> P.O. Box 17661 INSURERD:
<br /> Tucson AZ 85730 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 CONTRACTOR 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 ADDLSUBTYPE OF INSURANCE INSp WVp POLICY NUMBER /Y POLICY EFF POLICY EXP
<br /> LTR MM/DDYYY D /Y MM DYYY LIMITS
<br /> X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $2,000,000
<br /> A CLAIMS-MADE �OCCUR DAM MISES occurrence)AGE TO RENTED $300,000
<br /> X X 59SBAZM4677 12/08/2025 12/08/2026 MED EXP(Any oneperson) $ 10,000
<br /> PERSONAL&ADV INJURY $2,000,000
<br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $4,000,000
<br /> X POLICY ECT LOC PRODUCTS-COMP/OP AGG $4,000,000
<br /> OTHER: $
<br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $2,000,000
<br /> (Fa acc dent)
<br /> A ANY AUTO BODILY INJURY(Per person) $
<br /> OWNED SCHEDULED 59SBAZM4677 12/08/2025 12/08/2026 BODILY INJURY(Per accident) $
<br /> AUTOS ONLY AUTOS
<br /> HIRED NON-OWNED PROPERTY DAMAGE
<br /> X AUTOS ONLY X AUTOS ONLY $
<br /> UMBRELLA LAB OCCUR EACH OCCURRENCE $
<br /> EXCESS LAB CLAIMS-MADE AGGREGATE $
<br /> DEDT I RETENTION$ $
<br /> WORKERS COMPENSATION X I PER LITE OTH-
<br /> AND EMPLOYERS'LIABILITY
<br /> STAT
<br /> ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT $ 1,000,000
<br /> A OFFICER/MEMBER EXCLUDED? ❑N N/A X 59WECGC6729 01/08/2026 01/08/2027
<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 /> $1,000,000 each Glitch Limit
<br /> A Errors&Omissions Liability 59SBAZM4677 12108/2025 12/0812026 $2,000,000 Aggregate
<br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
<br /> City of Santa Ana,its City Council,officers,officials,employees,agents,and volunteers are automatically included as additional insured on
<br /> the general liability insurance when required by written contract. Waiver of subrogation applies in favor of the certificate holder on the
<br /> general liability and workers compensation insurance when required by written contract.See attached form.
<br /> Digitally signed
<br /> Tu Tran byTuTran
<br /> Nguyen
<br /> All forms when required b written contract are subject to policy forms and condi Date:2 APPROVED
<br /> q Y 1 p Y I��ren Date:zozs.,z.oa
<br /> ,o:a9so-os'oo'
<br /> By Tu Tran Nguyen at 10:49 am,Dec 08, 2025
<br /> CERTIFICATE HOLDER CANCELLATION
<br /> City of Santa Ana SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br /> Risk Management Division ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> 20 Civic Center Plaza
<br /> Santa Ana,CA 92702 AUTHORIZED REPRESENTATIVE /I
<br /> ©1988-2015 ACORD CORPORATION. All rights reserved.
<br /> ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD
<br />
|