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ACORbr CERTIFICATE OF LIABILITY INSURANCE <br />11,.� <br />DATE(MM/DD/YYYY) <br />1 12/13/2024 <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 />Burnham WGB Insurance Solutions <br />CA Insurance License OF69771 <br />15901 Red Hill Avenue <br />Tustin CA 92760 <br />CONTACT <br />NAME: Michael Tran <br />PHONNo,E 714-824-8384 ac Ne714-573-1770 <br />AIL <br />ADDRESS: michael.tran w bib.com <br />INSURERS AFFORDING COVERAGE <br />NAIC# <br />INSURERA: State Compensation Insurance F <br />35076 <br />INSURED NATIO14 <br />National Safety Services, Inc. <br />9121 Atlanta Ave Unit #732 <br />INSURER B : Crum & Forster Specialty Insur <br />44520 <br />INSURER c: AMCO Insurance Company <br />19100 <br />INSURERD: <br />Huntington Beach CA 92646 <br />INSURER E <br />INSURER F : <br />COVERAGES CERTIFICATE NUMBER: 1889759837 REVISION NUMRFR- <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 />SUER <br />IWD <br />POLICY NUMBER <br />POLICY BEE <br />MMIDDIYYYY <br />POLICY EXP <br />IMMIDDini <br />LIMITS <br />B <br />X <br />COMMERCIAL GENERAL LIABILITY <br />CLAIMS -MADE OCCUR <br />Y <br />EPK146720 <br />2/1/2024 <br />2/1/2025 <br />EACH OCCURRENCE <br />$1,000,000 <br />DAMAGE TO KtN I ED <br />PREMISES Ea occurrence <br />$50,000 <br />MED EXP (Any one person) <br />$ 5.000 <br />PERSONAL &ADV INJURY <br />$1.000,000 <br />GEN'L <br />AGGREGATE LIMIT APPLIES PER: <br />GENERALAGGREGATE <br />$2.000,000 <br />POLICY PED DOE <br />PRODUCTS - COMP/OP AGG <br />$2.000.000 <br />Deductible <br />$5.000 <br />OTHER: <br />C <br />AUTOMOBILE <br />LIABILITY <br />Y <br />Y <br />ACP3009636948 <br />2/1/2024 <br />2A/2025 <br />COMBINED SINGLE LIMIT <br />Ea accident <br />1,000,000 <br />$ <br />AUTO <br />BODILY INJURY(Per person) <br />$ <br />OWNED SCHEDULED <br />AUTOS ONLY AUTOS <br />IANY <br />BODILY INJURY(Peraccident <br />1HIRED <br />$ <br />X NON -OWNED <br />AUTOS ONLY AUTOS ONLY <br />PROPERTY e ident) AGE <br />Per accident <br />$ <br />B <br />UMBRELLALIAB <br />X <br />OCCUR <br />EFX124635 <br />2/1/2024 <br />2/1/2025 <br />EACH OCCURRENCE <br />$1,000.000 <br />X <br />AGGREGATE <br />$1,000,000 <br />EXCESS LIAR <br />CLAIMS -MADE <br />DED I I RETENTION$ <br />$ <br />A <br />WORKERS COMPENSATION <br />AND EMPLOYERS'LIABILITY Y/N <br />Y <br />912408a2O24 <br />2/4/2024 <br />2/4/2025 <br />X STATUTE �RH <br />E.L. EACH ACCIDENT <br />$1,000,000 <br />ANYPROPRIETOR/PARTNEWEXEWTIVE <br />OFFICER/MEMBER EXCLUDED? ❑ <br />NIA <br />E.L. DISEASE -EA EMPLOYEE <br />$Included <br />(Mandatory in NH) <br />If yes, describe under <br />E.L. DISEASE -POLICY LIMIT <br />$Included <br />DESCRIPTION OF OPERATIONS below <br />B <br />Professional Liability <br />EPK146720 <br />2/1/2024 <br />2/1/2025 <br />$1,000.000 Limit <br />$5,000 Deductible <br />DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached ifmore space is required) <br />RE: N-2023-075. <br />City of Santa Ana, its officers, officials, employees, and volunteers are named as additional insured on the General Liability per attached EN0351 0217 & <br />EN0350 0217 as required by written contract subject to the terms and conditions of the policy. Primary and Non -Contributory applies on the General Liability per <br />attached EN0348 0217. Waiver of Subrogation applies to the General Liability per attached EN0349 0217. <br />30-Day Notice of Cancellation (other than non -pay) applies per attached EN0136-0211. APPROVED <br />THIS CERTIFICATE SUPERCEDES ANY PREVIOUSLY ISSUED. By Cynthia Mora at 11:54 am, Dec 19, 2024 <br />City of Santa Ana <br />Risk Management Division <br />20 Civic Center Plaza, 4th Floor <br />Santa Ana CA 92701 <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 />n 19RR-2015 ACORD CORPORATION All rinht. rccc..md <br />ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD <br />