YAMADA ENTERPRISES (J. K. MIKLIN, INC.)

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A�® CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDI2`) 9/17/2 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 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 Sun Park NAME: ( n FAX Conrey Ins Brokers & Risk Managers IA/C.No.E%tl: (877)450-1872 (A/C,NOJ: (7141 83 8-816 6 2522 N. Santiago Blvd. E-MAIL ADDRESS: conre sunp y @ ins.com Lic#0543173 Orange Angie NSURERA:l:r,OCtsrn � nc� p_ by Angi� ^7c a INSURED INSURERS:Y IT4/y��q(��;,k�/Q�}elle, & Indemnity Company 22357 J K Miklin Inc INSURER C: is-tTorci-�as`ua-ltyy Insurance Comp 29424 DBA: Yamada Enterpri s INSURERr_Date: 2024.09.19 11 .25.1-9 16552 gtone each C e)e d o INFU F. Huntington Beach 6 4 JPP.,_RF: _071001 COVERAGES CERTIFICATE NUMBER:24-25 GL AU >rW,; UM 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 ADDL SUER POLICY EFF POLICY EXP LTR TYPE OF INSURANCE JNSD W1(a. POLICY NUMBER JMMIDDIYYYYI JMM/DDIYYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS-MADE X OCCUR DAMAGE TO RENTED 100,000 PREMISES(Ea occurrence) $ X Deductible/SIR = $500 X Y CPS8057350 8/21/2024 8/21/2025 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY X I CT LOC PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER: 5 • AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) B X ANY AUTO BODILY INJURY(Per person) 5 ALL OWNED SCHEDULED AUTOS AUTOS X y 72UECCK8998 8/21/2024 8/21/2025 BODILY INJURY(Per accident) S _ NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS (Per accident) 5 _ Medical payments S 5,000 X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000 A EXCESS LIAB CLAIMS-MADE AGGREGATE $ 5,000,000 DED X RETENTION S 10,000 X Y CXS4031608 8/21/2029 8/21/2025 WORKERS COMPENSATION X PER OTH- AND EMPLOYERS'LIABILITY YIN STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? y N IA C (Mandatory in NH) y 72WECAY6EDT 8/21/2029 8/21/2025 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) RE: RFP #24-080A - Library Public Furniture & Modular Office Furniture Services. WITH RESPECTS TO GENERAL LIABILITY, CERTIFICATE HOLDERS ARE NAMED AS ADDITIONAL INSURED WHEN REQUIRED BY WRITTEN CONTRACT PER FORMS CG20381219 & CG20391219. BLANKET WAIVER OF SUBROGATION PER FORM CG24531219. THIS COVERAGE IS PRIMARY & NON-CONTRIBUTORY PER FORM CG20011219. AS RESPECTS COMMERCIAL AUTO BROAD FORM ENDORSEMENT HA99161221: BLANKET ADDITIONAL INSURED ON A PRIMARY AND NON-CONTRIBUTORY BASIS IF REQUIRED BY CONTRACT. WAIVER OF SUBROGATION APPLIES. AS RESPECTS WORKERS' COMPENSATION: BLANKET WAIVER OF SUBROGATION OFFICERS EXCLUDED - PARKER BRAVERMAN POLICY CONTAINS 30 DAY CANCELLATION CLAUSE. 10 DAYS NOTICE IN THE CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE I City of Santa Ana THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN 20 Civic Center Plaza ACCORDANCE WITH THE POLICY PRO\\ / o0,i. RMansgernentDivisitm Santa Ana, CA 92701 ialc AUTHORIZED REPRESENTATIVE z REVIEWED6 APPROVED By: s;' Sun Park/JOC '®' I Risk Management Specialist ©1988-2014 ACORD 1/ ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD INS025(201901)