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TEROBERT-0 SCATES
<br /> ,d►coRO CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY)
<br /> 2/4/2026
<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#0757776 CONTACT
<br /> NAME:
<br /> HUB International Insurance Services Inc. PHONE FAX
<br /> 4695 MacArthur Court (A/C,No,Ext): (949) 623-3980 No):(949) 891-0407
<br /> Suite 600 E-MAIL
<br /> DD RIESS:
<br /> Newport Beach,CA 92660
<br /> INSURERS AFFORDING COVERAGE NAIC#
<br /> INSURERA:CUMIS Insurance Society, Inc. 10847
<br /> INSURED INSURER B:CorePointe Insurance Company 10499
<br /> T.E Roberts,Inc. INSURERC:Indian Harbor Insurance Company 36940
<br /> 17771 Mitchell North INSURER D7
<br /> Irvine,CA 92614
<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 TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS
<br /> LTR INSD WVD MM/DD/YYYY MM/DD/YYYY
<br /> A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
<br /> CLAIMS-MADE X OCCUR 325997 9/1/2025 9/1/2026 rl DAMAGE TO RENTED 1,000,000
<br /> X PREMISES Ea occurrence $
<br /> MED EXP(Any oneperson) $ 5,000
<br /> PERSONAL&ADV INJURY $ 1,000,000
<br /> GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000
<br /> POLICY�X PEI° LOC PRODUCTS-COMP/OPAGG $ 2,000,000
<br /> OTHER: EBL AGGREGATE L $ 2,000,000
<br /> A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000
<br /> Ea accident $
<br /> X ANY AUTO X 325999 9/1/2025 9/1/2026 BODILY INJURY Perperson) $
<br /> OWNED SCHEDULED
<br /> AUTOS ONLY AUTOS BODILY INJURY Per accident $
<br /> X HIRED X NON-OWNED PROPERTY DAMAGE
<br /> AUTOS ONLY AUTOS ONLY Per accident)
<br /> ccident $
<br /> A UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000
<br /> X EXCESS LIAB CLAIMS-MADE 325972 9/1/2025 9/1/2026 AGGREGATE $ 5,000,000
<br /> DED X RETENTION$ 10,000 $
<br /> B WORKERS COMPENSATION X PER STATUTE E ERR
<br /> AND EMPLOYERS'LIABILITY
<br /> Y/N CTP1004191 9/1/2025 9/1/2026 1,000,000
<br /> ANY PROPRIETOR/EXCLUDED?
<br /> R/EXECUTIVE ❑ E.L.EACH ACCIDENT $
<br /> OF EXCLUDED? N/A
<br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000
<br /> If yes,describe under 1,000,000
<br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $
<br /> C Professional Liab. X PECO05263607 9/1/2025 9/1/2026 Per Occurrence Limit 5,000,000
<br /> C Pollution/Environm. PECO05263607 9/1/2025 9/1/2026 Aggregate Limit 10,000,000
<br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached if more space is required)
<br /> Re: Large Water Services Vault and Meter Apparatus Improvements
<br /> The City of Santa Ana,its City Council,its officers,officials,employees,agents,and volunteers are included as additional insured as respects general
<br /> liability,auto liability,and professional liability with respect to any liability arising out of work or operations performed by or on behalf of the Instructor
<br /> including materials,parts,equipment,and personnel furnished in connections with such work or operations.Coverage is primary and non-contributory,
<br /> subject to the terms and conditions of the policy and attached forms.30 day notice of cancellation,except 10 days for non-payment.
<br /> APPROVED
<br /> CERTIFICATE HOLDER CANCELLATION By Tu Tran Nguyen at 10:06 am,Feb 06,2026
<br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> City of Santa Ana THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br /> Y ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> 20 Civic Center Plaza,4th Floor
<br /> Santa Ana,CA 92701
<br /> AUTHORIZED REPRESENTATIVE
<br /> ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved.
<br /> The ACORD name and logo are registered marks of ACORD
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