|
EVERSOL-01 EREDMON
<br /> �►co�ro CERTIFICATE OF LIABILITY INSURANCE FDATE(MM/DD/YYYY)
<br /> `.�• 8/14/2025
<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:
<br /> Hub International Florida PHONE FAX
<br /> 1117 Thomasville Road (A/C,No,Ext): (850) 386-1111 (A/C,No):(850) 385-9827
<br /> Tallahassee,FL 32303 ADDRESS:
<br /> INSURERS AFFORDING COVERAGE NAIC#
<br /> INSURERA:Cincinnati Indemnity Company 23280
<br /> INSURED INSURER B:Twin City Fire Insurance Company 29459
<br /> Evergreen Solutions,LLC INSURER 7
<br /> 2528 Barrington Circle Unit 201 INSURER D:
<br /> Tallahassee,FL 32308
<br /> 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 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 TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS
<br /> LTR INSD WVD MMIDD/YYYY MMIDD/YYYY
<br /> A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
<br /> CLAIMS-MADE X OCCUR ENP0586601 8/17/2025 8/17/2026 DAMAGE TO RENTED 500,000
<br /> X X PREMISES Ea occurrence $
<br /> MED EXP(Any oneperson) $ 10,000
<br /> PERSONAL&ADV INJURY $ 1,000,000
<br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000
<br /> X POLICY PELT LOC PRODUCTS-COMP/OPAGG $ 2,000,000
<br /> OTHER: $
<br /> A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000
<br /> Ea accident $
<br /> ANY AUTO X X EBA0586601 8/17/2025 8/17/2026 BODILY INJURY Perperson) $
<br /> OWNED SCHEDULED
<br /> AUTOS ONLY AUTOS BODILY INJURY Per accident $
<br /> X HIRED X NON-OWNED PROPERTY DAMAGE
<br /> AUTOS ONLY AUTOS ONLY Per accident $
<br /> A X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 2,000,000
<br /> EXCESS LIAB CLAIMS-MADE ENP0586601 8/17/2025 8/17/2026 AGGREGATE $
<br /> DED RETENTION$ Aggregate $ 2,000,000
<br /> WORKERS COMPENSATION PER OTH-
<br /> AND EMPLOYERS'LIABILITY Y/N STATUTE ER
<br /> ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ E.L.EACH ACCIDENT $
<br /> OFFICER/MEMBER EXCLUDED? N/A
<br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $
<br /> If yes,describe under
<br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $
<br /> B Errors&Omissions/P X 21 PG 0567622-25 8/17/2025 8/17/2026 Per Claim 3,000,000
<br /> B Errors&Omissions/P 21 PG 0567622-25 8/17/2025 8/17/2026 Aggregate 3,000,000
<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 included as an Additional Insured for General Liability&Auto
<br /> Liability,&Waiver of Subrogation applies for General Liability,Auto Liability,Workers'Compensation&Professional Liability,when required in a written
<br /> contract or agreement with the Insured,per the terms&conditions of the policies endorsements.Umbrella/Excess coverage is subject to(follows)the terms
<br /> &conditions of the underlying General Liability,Auto Liability,&Employers'Liability policy endorsements.Policy cancellation clause is 30 days except 10
<br /> days for nonpayment of premium Digitally signed
<br /> TU Tran by Tu Tran
<br /> Nguyen
<br /> Nguyen°;o94ozo�oo4 4PPROVED
<br /> CERTIFICATE HOLDER CANCELLATION By Tu Tran Nguyen at 11:09 am Aug 14,2020.
<br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> City of Santa Ana THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br /> ty ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> Attention: Human Resources Agency
<br /> 20 Civic Center Plaza, M-24
<br /> Santa Ana,CA 92701 AUTHORIZED REPRESENTATIVE
<br /> ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved.
<br /> The ACORD name and logo are registered marks of ACORD
<br />
|