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BIGBENC-01
<br />KVINOKUR
<br />r
<br />ACOROW CERTIFICATE OF LIABILITY INSURANCE
<br />`64��
<br />DATE(MM/DD/YYYY)
<br />4/7/2025
<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 License # OM70471
<br />CONTACT Karin Vinokur
<br />NAME:
<br />PHONE FAX No):(949) 263-8860
<br />(A/C, No, Ext): (949) 942-1100
<br />Orion Risk Management Insurance Services, An Alera Group Insurance
<br />Agency, LLC
<br />18575 Jamboree Rd, Suite 500
<br />E-MAIL-ADDRESS: kvinokur@orionrisk.com
<br />Irvine, CA 92612
<br />INSURERS AFFORDING COVERAGE
<br />NAIC #
<br />INSURERA:Starr Surplus Lines Ins. Co.
<br />13604
<br />INSURED
<br />INSURER B : The Travelers Indemnity Company of Connecticut
<br />25682
<br />INSURER C : TRAVELERS PROPERTY CASUALTY COMPANY OF AMERICA
<br />25674
<br />Big Ben, Inc.
<br />INSURER D : Travelers Casualty and Surety Company of America
<br />19038
<br />4790 Irvine Blvd. #105-404
<br />Irvine, CA 92620
<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
<br />LTR
<br />TYPE OF INSURANCE
<br />ADDL
<br />INSD
<br />SUBR
<br />WVD
<br />POLICY NUMBER
<br />POLICY EFF
<br />MM/DD/YYYY
<br />POLICY EXP
<br />MM/DD/YYYY
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />rl
<br />CLAIMS -MADE X OCCUR
<br />X
<br />X
<br />1000066896251
<br />4/5/2025
<br />4/5/2026
<br />DAMAGE TO RENTED
<br />PREMISES Ea occurrence
<br />100,000
<br />$
<br />MED EXP (Any oneperson)
<br />$ 5,000
<br />PERSONAL & ADV INJURY
<br />$ 2,000,000
<br />GENT
<br />AGGREGATE LIMIT APPLIES PER:
<br />GENERAL AGGREGATE
<br />$ 2,000,000
<br />POLICY X 71 PEA LOC
<br />PRODUCTS - COMP/OP AGG
<br />$ 2,000,000
<br />$
<br />OTHER:
<br />B
<br />AUTOMOBILE
<br />LIABILITY
<br />COMBINED SINGLE LIMIT
<br />Ea accident
<br />1,000,000
<br />$
<br />X
<br />BODILY INJURY Perperson)
<br />$
<br />ANY AUTO
<br />X
<br />X
<br />8101Y968117
<br />7/1/2024
<br />7/1/2025
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />BODILY INJURY Per accident
<br />$
<br />PROPERTY DAMAGE
<br />Per accident)
<br />ccident
<br />$
<br />HIRED NON -OWNED
<br />AUTOS ONLY AUTOS ONLY
<br />A
<br />UMBRELLA LIAB
<br />X
<br />OCCUR
<br />EACH OCCURRENCE
<br />$ 12,000,000
<br />X
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />X
<br />1000337275251
<br />4/5/2025
<br />4/5/2026
<br />AGGREGATE
<br />$
<br />DED RETENTION $
<br />Aggregate
<br />$ 12,000,000
<br />C
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY
<br />ANY PROPRIETOR/ R/EXECUTIVE ❑
<br />OFFICER/MEMBER EXCLUDED?
<br />EXCLU
<br />(Mandatory in NH)
<br />N/A
<br />A
<br />X
<br />UB2Y00643624
<br />7/1/2024
<br />7/1/2025
<br />TH-
<br />X STATUTE ER PER R E
<br />E.L. EACH ACCIDENT
<br />1,000,000
<br />$
<br />E.L. DISEASE - EA EMPLOYEE
<br />$ 1,000,000
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE - POLICY LIMIT
<br />1,000,000
<br />$
<br />A
<br />Pollution Liability
<br />1000066896251
<br />4/5/2025
<br />4/5/2026
<br />D
<br />Equipment Floater
<br />6607NO92607
<br />4/5/2025
<br />4/5/2026
<br />Rented/Leased Equip
<br />160,000
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required)
<br />The City of Santa Ana, its officers, employees, agents and representatives are included as additional insured on a primary basis per the terms of the attached
<br />General Liability and Auto Liability endorsements. Umbrella follows form over GL and Auto. Waiver of Subrogation applies in favor of additional insured per
<br />the terms of the attached General Liability, Auto Liability and Workers Compensation endorsements.
<br />Tu TfdTran
<br />ll by Tu Tran Digitally ned APPROVED
<br />Nguyen
<br />Ng Uyen Date: 2025.04.09 By Tu Tran Nguyen at 11:44 am, Apr 09, 2025
<br />11:45:08-07'00'
<br />City of Santa Ana.
<br />Attention: Leif Lovegren
<br />215 S. Center Street
<br />Santa Ana, CA 92703
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />AUTHORIZED REPRESENTATIVE
<br />Kalle, dlteAll
<br />ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved.
<br />The ACORD name and logo are registered marks of ACORD
<br />
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