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<br />COI ID: 4MGKV
<br />.-- ®
<br />D ACORCERTIFICATE OF LIABILITY INSURANCE
<br />DATE (MM/DD/YYYY)
<br />03/03/2025
<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
<br />CONTACT Dustin Keeney
<br />PAHONNo Ext : 8884671718 FAX No
<br />WRIS, Inc. dba Western Republic Insurance Services
<br />E-MAIL ADDRESS: dustin@wrinsurance.com
<br />19900 Beach Blvd.
<br />INSURER(S) AFFORDING COVERAGE
<br />NAIC#
<br />Suite F1
<br />INSURERA: Colony Insurance Company
<br />39993
<br />Huntington Beach CA 92648
<br />INSURED
<br />INSURER B : California Automobile Insurance Company
<br />38342
<br />Golden Meters Service, Inc.
<br />Scottsdale IC
<br />INSURER C : Insurance Company Y
<br />41297
<br />14812 Hunter Ln
<br />INSURER D: Security National Insurance Company
<br />33120
<br />INSURER E :
<br />INSURER F :
<br />Midway City CA 92655
<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 />I
<br />SUBR
<br />POLICY NUMBER
<br />POLICY EFF
<br />MM/DD/YYYY
<br />POLICY EXP
<br />MM/DD/YYYY
<br />LIMITS
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />CLAIMS -MADE � OCCUR
<br />PREM SESDAMAGE TOEa olccurrDence
<br />$ 100,000
<br />MED EXP (Any one person)
<br />$ 5,000
<br />PERSONAL & ADV INJURY
<br />$ 1,000,000
<br />A
<br />Y
<br />Y
<br />600 GL 0217377-00
<br />09/09/2024
<br />09/09/2025
<br />GEN'L
<br />AGGREGATE LIMIT APPLIES PER:
<br />GENERAL AGGREGATE
<br />$ 2,000,000
<br />POLICY PRO LOC
<br />JECT
<br />X
<br />PRODUCTS-COMP/OPAGG
<br />$ 2,000,000
<br />$
<br />OTHER:
<br />AUTOMOBILE
<br />LIABILITY
<br />COMBINED SINGLE LIMIT
<br />Ea ccident
<br />a
<br />$ 1,000,000
<br />BODILY INJURY (Per person)
<br />$
<br />ANY AUTO
<br />B
<br />OWNED \/ SCHEDULED
<br />AUTOS ONLY I ^ I AUTOS
<br />Y
<br />Y
<br />BA040000088824
<br />04/15/2024
<br />04/15/2025
<br />BODILY INJURY (Per accident)
<br />$
<br />PROPERTY DAMAGE
<br />Per accident
<br />$
<br />XHIRED
<br />Fs,,01 NON -OWNED
<br />AUTOS ONLY /� AUTOS ONLY
<br />UMBRELLA LIAB
<br />X
<br />OCCUR
<br />EACH OCCURRENCE
<br />$ 4,000,000
<br />C
<br />X
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />CXS4032619
<br />09/09/2024
<br />09/09/2025
<br />AGGREGATE
<br />$ 4,000,000
<br />DED RETENTION $
<br />$
<br />D
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY
<br />OFFCERMEMBEREXCLUDEDXECUTIVE Y❑
<br />(Mandatory in NH)
<br />NIA
<br />Y
<br />SWC1540465
<br />03/07/2025
<br />03/07/2026
<br />X STATUTE OERH
<br />E.L.EACH ACCIDENT
<br />$ 1,000,000
<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 />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
<br />Those usual to the insured's operations. City of Santa Ana, officers, agents, employees, and volunteers are named as additional insured per the attached CG 20
<br />10 12 19, CG 20 37 12 19, and MCA20480711. Waiver of subrogation applies per the attached CG 24 04 12 19, MCA04440913, and WC 04 03 06. Insurance is
<br />primary and non-contributory per the attached CG 20 01 12 19. Provide On -Call Meter Testing Services
<br />D g tally s,n,d
<br />-
<br />Tu Tran Ngw nrAPPROVED
<br />Nguyen 25.03.04 y Tu Tian Nguyen at 2a5 pis, Mar 04, 2025
<br />14:5848-08'00'
<br />CERTIFICATE HOLDER CANCELLATION
<br />City of Santa Ana
<br />Attention: Public Works Agency Water, 215 S. Center Street (M-85)
<br />Santa Ana
<br />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 />i
<br />©1988-2015 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
<br />COI ID: 4MGKV
<br />Generated using Certificial's Smart COI Network TM — Track your Suppliers in real-time at certificial.com/coi
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