|
71/29/2026
<br /> E(MM/DD/YYYY)
<br /> A�" CERTIFICATE OF LIABILITY INSURANCE
<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: Valerie Dehus
<br /> The Baldwin Group West, LLC PHONE 714 505-7007 FAX
<br /> No:(714 573-1770
<br /> 15901 Red Hill Ave, Ste 100 A/C No Ext: ( ) )
<br /> Tustin CA 92780 ADDE-MRESS: Valerie.Dehus@Baldwin.com
<br /> INSURER(S)AFFORDING COVERAGE NAIC#
<br /> INSURERA: State Compensation Insurance F 35076
<br /> INSURED NATIO14 INSURER B: Lloyd's of London 15792
<br /> National Safety Services, Inc. INSURERC: United Financial Casualty Co 11770
<br /> 5562 Research Dr, Unit B
<br /> Huntington Beach CA 92649 INSURER D: Palms Insurance Company, Ltd
<br /> INSURER E:
<br /> INSURER F:
<br /> COVERAGES CERTIFICATE NUMBER:1323054832 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 POLICYNUMBER MM/DD MM/DD
<br /> B X COMMERCIAL GENERAL LIABILITY Y Y CSIEL01883-01 2/1/2026 2/1/2027 EACH OCCURRENCE $1,000,000
<br /> DAMAGE S( RENTED
<br /> CLAIMS-MADE OCCUR
<br /> PREMISES Ea occurrence)
<br /> ccurrence) $100,000
<br /> MED EXP(Any one person) $10,000
<br /> PERSONAL&ADV INJURY $1,000,000
<br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000
<br /> PRO-
<br /> POLICY� ECT1:1 LOC PRODUCTS-COMP/OP AGG $2,000,000
<br /> X OTHER: DED$5,000 Pollution Liability $1,000,000
<br /> C AUTOMOBILE LIABILITY Y Y 992664368 2/4/2026 8/4/2026 COMBINED SINGLE LIMIT $1,000,000
<br /> Ea accident
<br /> ANY AUTO BODILY INJURY(Per person) $
<br /> OWNED X SCHEDULED BODILY INJURY(Per accident) $
<br /> AUTOS ONLY AUTOS
<br /> X HIRED NON-OWNED PROPERTY DAMAGE $
<br /> AUTOS ONLY AUTOS ONLY Per accident
<br /> D X UMBRELLA LAB X OCCUR CSIXEL00751-01 2/1/2026 2/1/2027 EACH OCCURRENCE $5,000,000
<br /> EXCESS LAB CLAIMS-MADE AGGREGATE $5,000,000
<br /> DED RETENTION$ $
<br /> A WORKERS COMPENSATION Y 91240802026 2/4/2026 2/4/2027 X PER OTH-
<br /> AND EMPLOYERS'LIABILITY Y/N STATUTE ER
<br /> ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $1,000,000
<br /> OFFICER/MEMBER 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 /> D Professional Liability CSIPMPL00253-01 2/1/2026 2/1/2027 Each Claim Limit $1,000,000
<br /> Aggregate Limit $2,000,000
<br /> Deductible 10,000
<br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
<br /> City of Santa Ana, its City Council,officers,officials,employees,agents,and volunteers are included as Additional Insured with respect to General Liability,
<br /> Auto, Professional Liability, Pollution Liability.General Liability Primary and Non-Contributory per the attached. Waiver of Subrogation with respects to General
<br /> Liability,Auto, Professional Liability, Pollution Liability and Workers'Compensation if required by written contract and subject to terms,conditions and
<br /> exclusions of the policy,per the attached form.30 Day NOC per the attached form.
<br /> APPROVED
<br /> CERTIFICATE HOLDER CANCELLATION By Tu Tran Nguyen at 12:14 pm,Feb 02,2026
<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 /> Attention: Heidi Chou
<br /> 215 S. Center St., M-85 AUTHORIZED REPRESENTATIVE
<br /> Santa Ana CA 92701 >—
<br /> @ 1988-2015 ACORD CORPORATION. All rights reserved.
<br /> ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD
<br />
|