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DATE(MM/DD/YYYY) <br /> A�" CERTIFICATE OF LIABILITY INSURANCE 8/18/2025 <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 /> Roger Stone Insurance Agency PHONE FAX <br /> 5015 Birch Street A/C No Ext: 949-265-4167 vc,No):949-757-0375 <br /> E-MNewport Beach CA 92660 ADDRESS: josie@stoneins.com <br /> INSURER(S)AFFORDING COVERAGE NAIC# <br /> INSURERA:Admiral Insurance Co. 24856 <br /> INSURED ULTRENV-01 INSURERB: Hartford Casualty Insurance Company 29424 <br /> Ultrasystems Environmental Inc. <br /> 16431 Scientific Way INSURERC: <br /> Irvine CA 92618 INSURERD: <br /> INSURER E: <br /> INSURER F: <br /> COVERAGES CERTIFICATE NUMBER:1168811609 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 EFF POLICY EXP LIMITS <br /> LTR INSD WVD POLICY NUMBER MM/DD MM/DD <br /> A X COMMERCIAL GENERAL LIABILITY Y FEIECC1110712 11/10/2024 11/10/2025 EACH OCCURRENCE $5,000,000 <br /> CLAIMS-MADE OCCUR PREMISES DAMAGE TO <br /> PREMISES Ea occurrence) <br /> ccurrence $50,000 <br /> MED EXP(Any one person) $5,000 <br /> PERSONAL&ADV INJURY $5,000,000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $5,000,000 <br /> POLICY PRO JECT LOC PRODUCTS-COMP/OP AGG $5,000,000 <br /> X <br /> OTHER: $ <br /> A AUTOMOBILE LIABILITY FEIECC1110712 11/10/2024 11/10/2025 COEaMB ccidentoenos NGLE LIMIT $1,000,000 <br /> a <br /> ANY AUTO BODILY INJURY(Per person) $ <br /> OWNED SCHEDULED BODILY INJURY(Per accident) $ <br /> AUTOS ONLY AUTOS <br /> X HIRED X NON-OWNED FIR ERTYDAMAGE $ <br /> AUTOS ONLY AUTOS ONLY Per accident <br /> UMBRELLALIAB OCCUR EACH OCCURRENCE $ <br /> EXCESS LIAB CLAIMS-MADE AGGREGATE $ <br /> DED RETENTION$ $ <br /> B WORKERS COMPENSATION Y 72WECAT3CHK 9/1/2025 9/1/2026 X PER OTH- <br /> AND EMPLOYERS'LIABILITY Y/N STATUTE ER <br /> ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $1,000,000 <br /> OFFICE R/M EMBER EXCLUDED? ❑ N/A <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 /> A PROF LIAB RETRO DATE 9/9/1994 FEIECC1110712 11/10/2024 11/10/2025 EACH OCCURRENCE 5,000,000 <br /> CONTRACTORS POLLUTION LIABILITY EACH OCCURRENCE 5,000,000 <br /> GEN AGGREGATE LIMIT 5,000,000 <br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached if more space is required) <br /> RE: Environmental consulting-City of Santa Ana On-Call Environmental and Planning Services Related to CEQA and NEPA Base Contract I RFQ No.20-100 <br /> The City of Santa Ana, its officers,employees,agents and representatives are named Additional Insured as respects General Liability. Insurance is <br /> primary/non-contributory.Waiver of subrogation applies as respects Workers Compensation. Blanket endorsement forms ECC-319-0712, ECC-548-0317 and <br /> WC040306 attached. Digitallysigned <br /> Tu Tran by Tu Tran <br /> Nguyen <br /> Nguyen Date:2025.08.18 <br /> 16:22:51-m'oo' f�APPROVED <br /> CERTIFICATE HOLDER CANCELLATION Tu Tran Nguyen at 4:22 pm,Aug 18,2025 <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> City Of Santa Ana ACCORDANCE WITH THE POLICY PROVISIONS. <br /> Planning and Building Agency <br /> 20 Civic Center Plaza AUTHORIZED REPRESENTATIVE <br /> Santa Ana CA 92701 <br /> ©1988-2015 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD <br />