|
ACOR" CERTIFICATE OF LIABILITY INSURANCE
<br />2/1/2026
<br />1
<br />DATE (MM/DDIYYYY)
<br />2/13/2025
<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.
<br />A statement on
<br />this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
<br />PRODUCER LOCkton Companies, LLC
<br />CONTACT
<br />NAME:
<br />DBA LOckton Insurance Brokers, LLC In CA
<br />CA license #OF] 5767
<br />8110 E Union Ave., Ste. 100
<br />PHONE FAX
<br />o Ext : A/CNo
<br />E-MAIL
<br />ADDRESS:
<br />Denver CO 80237
<br />INSURER(S) AFFORDING COVERAGE
<br />NAIC #
<br />INSURER A: Crum & Forster Specialty Insurance Co
<br />44520
<br />denver-cents lockton.com
<br />INSURED Rincon Consultants, Inc.
<br />1462718 180 N Ashw'ood Ave.
<br />INSURER B : Hartford Fire Insurance Company
<br />19682
<br />INSURER C : Crum and Forster Insurance Company
<br />42471
<br />INSURER D : Palomar Excess and Surplus Insurance Co.
<br />16754
<br />Ventura CA 93003
<br />INSURER E: Starstone National Insurance Company
<br />25496
<br />INSURER F :
<br />COVERAGES CERTIFICATE NUMBER: 16059509 REVISION NUMBER: XXXXXXX
<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/DDNYYY
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />Y
<br />Y
<br />EPK-150911
<br />2/1/2025
<br />2/1/2026
<br />EACH OCCURRENCE
<br />$ 4,000,000
<br />CLAIMS -MADE � OCCUR
<br />DAMAGES(RENTED
<br />PREMISES Ea occurrence)$
<br />100,000
<br />X
<br />MED EXP (Any one person)
<br />$ 10,000
<br />SIR: $50,000
<br />X
<br />P&I
<br />PERSONAL & ADV INJURY
<br />$ 4,000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />GENERAL AGGREGATE
<br />$ 4,000,000
<br />POLICY PRO- LOC
<br />PRODUCTS - COMP/OP AGG
<br />$ 4 000 000
<br />$
<br />OTHER:
<br />$
<br />AUTOMOBILE
<br />LIABILITY
<br />Y
<br />y
<br />72UENOL5481
<br />2/1/2025
<br />2/1/2026
<br />COMBINED SINGLE LIMIT
<br />Ea accident
<br />$ 1,000,000
<br />X
<br />BODILY INJURY (Per person)
<br />$ XXXXXXX
<br />ANY AUTO
<br />BODILY INJURY (Per accident)
<br />$ XXXXXXX
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />X
<br />PROPERTY DAMAGE
<br />Per accident
<br />$ XXXXXXX
<br />HIRED X NON -OWNED
<br />ONLY AUTOS ONLY
<br />Comp./Coll. Died
<br />$ 1,000
<br />C
<br />UMBRELLA LIAB
<br />X'
<br />OCCUR
<br />N
<br />N
<br />EFX-127832
<br />2/l/2025
<br />2/1/2026
<br />EACH OCCURRENCE
<br />$ 10,000,000
<br />D
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />CEEXP-25-0000094-00
<br />2/l/2025
<br />2/l/2026
<br />X
<br />AGGREGATE
<br />$ 10,000,000
<br />DED X RETENTION $ 10,000
<br />$ XXXXXXX
<br />E
<br />E
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY Y / N
<br />ANY PROPRIETOR/PARTNER/EXECUTIVE
<br />OFFICER/MEMBER EXCLUDED? F
<br />(Mandatory in NH)
<br />N / A
<br />y
<br />T10251427 FL)
<br />T 1025 1427 �F L)
<br />2/l/2025
<br />2/l/2025
<br />2
<br />2/1/2026
<br />2/ I /2026
<br />X STATUTE EORH
<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 />A
<br />Contractors Pollution Liab
<br />N
<br />N
<br />EPK-150911
<br />2/l/2025
<br />2/l /2026
<br />$4,000,000/$4,000,000
<br />E&O Liab.
<br />$4,000,000 ea. occ./$4,000,000 agg.
<br />Retro Datc: 12/9/1994
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required)
<br />THIS CERTIFICATE SUPERSEDES ALL PREVIOUSLY ISSUED CERTIFICATES FOR THIS HOLDER, APPLICABLE TO THE CARRIERS LISTED AND THE POLICY TERMI S) REFERENCED.
<br />Effective 2/l/2024-8/1/2025, Cyber Liability $5M Limit, $25k Retention, Carrier: HCC; Policy #H24NGP224923-01, $5M x $5M Limit, Carrier: Corvus, Policy #CXS-I07946155-00. The City of
<br />Santa Ana and Community Development Agency and their officers, employees, agents and volunteers are an Additional Insured to the extent provided by the policy language or endorsement issued or
<br />approved by the insurance carrier. Waiver of Subrogation applies per attached endorsententts) or policy language. Insurance provided to Additional Insured(s) is primary and non-contributory as per the
<br />attached endorsement or policy language. Excess policy follows General Liability, Auto Liability and Employers Liability form. Notice of Cancellation applies per the applicable policy language or
<br />endorsements. -"--"--""""""
<br />igitally
<br />Tu Tran TDran Nguyened by Tu APPROVED
<br />Nguyen Date: 2025.02.13
<br />10:51:42-08'00' By Tu Tran Nguyen at 10a 1 am, Feb 13, 2025,
<br />uaan�na:�
<br />16059509
<br />City of Santa Ana
<br />Attention: Planning and Building Department
<br />20 Civic Center Plaza, M-20
<br />Santa Ana CA 92701
<br />tLLA
<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 />(c7 1988-2(0) ACORD CORPORATION_ All rights reserved
<br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
<br />
|