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1 ® DATE(MMfDDIYYYYI <br /> ACORO CERTIFICATE OF LIABILITY INSURANCE <br /> `� 04/08/2024 <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 pollc (ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the <br /> A term and cortitions of the policy, certain policies may req�'I j g f dai grpetai1 g ILa RIJnjyhiQ nmit does not confer rights to the <br /> A e gb a gu I.-,,fi1 eu of such endorsements. ry J I Iel.l IJ�/ /-1 I <br /> P• • CE W CC TACT Michelle Nia <br /> Nia Insuran gency Inc.Lic#0B88707 Acev_(ALC,kJ FAX No): <br /> _tA/C.No.Emil.310-659,4950_ <br /> A41 Santa Monica Blvd#71 Date: �':� x <br /> ee e O S 19s ltfra G�Cweh 5 r <br /> Naic a <br /> C V _07I OO1suRER Al Liberty Mutual Insurance Company 043 <br /> —-- v V INSURED INSURER B: Infinity-Kemper Insurance Company 22268 <br /> SABP Inc. <br /> Embee Computer Design INSURER C: <br /> 17622 Armstrong Ave INSURER D__ <br /> Irvine,CA 92618 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 TFIE 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 /> ADDL SUBR POLICY EFF POLICY EXP <br /> LTR <br /> IN-SR <br /> - TYPE LIMITS <br /> OF INSURANCE INSR WVD POLICY NUMBER IMM1DDfYYYY) IMMIDD/YYY1'1 <br /> GENERAL LIABILITY EACH OCCURRENCE S 1 000,000. <br /> X 1 COMMERCIAL GENERAL LIABILITY I--- r-- PREMISES Ea occurrence S 500,000_ <br /> ]CLAIMS-MADE X OCCUR I X I R MED EXP(Any one person) 5 5,000. <br /> A BKO(25)63 31 54 66 05/02/2023 05/02/2025 PERSONAL&ADV INJURY S 1,000,000. <br /> GENERAL AGGREGATE S 2,000,000. <br /> GEN'L AGGREGATEj� LIMIT APPIES PER: PRODUCTS-COMP/OP AGG S 2 000 000. <br /> l n l PRO• 1-1 S <br /> X POLICY JECT LOC <br /> AUTOMOBILE LIABILITY (EaaecC dentD)SINGLE LIMIT I S 1 000 000. <br /> ANY AUTO BODILY INJURY(Per person) S <br /> ALL OWNED X SCHEDULED BODILY INJURY(Per accident) S <br /> B AUTOS X <br /> — NON-OWNED 504-61 0 1 5-6222-OD01 05/02/2023 05f02/2025 PROPERTY DAMAGE — <br /> HIRED AUTOS X AUTOS I (Per accident) — <br /> IS <br /> X UMBRELLA LIAB `X OCCUR EACH OCCURRENCE s 5,000,000. <br /> A EXCESS LIAB —I, CLAIMS-MADE F E ESA(25)63 31 54 66 05/02/2023 05/02/2025 AGGREGATE $5,000,000. <br /> X DED I I RETENTIONS S <br /> 1 WORKERS COMPENSATION I , ' I WCSTATU- I LOTH-I <br /> AND EMPLOYERS'LIABILITY TORY LIMITS ER <br /> ANY PROPRIETORIPARTNERiEXECUTIVE YIN E.L.EACH ACCIDENT I S - <br /> OFFICE/MEMBER EXCLUDED? N f A <br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYE S <br /> II yes,describe under E.L.DISEASE-POLICY LIMIT S <br /> nESCRIPTION OF OPERATIONc nslrnr i <br /> 1 Errors&Omissions BKO(25)63 31 54 66 05/02/2023 05/02/2025 <br /> $1,000,000.Per Claim <br /> A ;Equipment Floater I I $500,000.Equipment Aggregate Limit <br /> I I <br /> DESCRIPTION OF OPERATIONS!LOCATIONS!VEHICLES (Attach ACORD 101,Additional Remarks Schedule,I(more space Is required) <br /> Re:City of Santa Ana-Agreement for Scanning Services.City of Santa Ana is Additional Insured per attached endorsement. <br /> CERTIFICATE HOLDER CANCELLATION <br /> City of Santa Ana.Public Works Agency SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> THE EXPIRATION TE_—TNREOF, NOTICE WILL BE DELIVERED IN <br /> 20 Civic Center Plaza ACCORDANCE WIT PO Y PROVISIONS. <br /> Santa Ana,CA 92702 AUTNORIZer}rz P SEN ATIv�\ orz Risk MmlagernottDivision <br /> / <br /> / --',Fc <br /> ' REVIEWED&APPROVED BY: <br /> Michelle i at.(4' A A Aceuido <br /> ©19 8-2010 ACORD CI �rin <br /> ' Risk Management Specialist <br /> ACORD 25(2010/05) The ACORD name and logo are registered mar s of ORD <br />