|
ANCOMAR-01 JPAYNE
<br /> ACORO CERTIFICATE OF LIABILITY INSURANCE DATE(MM/ Y
<br /> 12/22/2025
<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 CONTACT Jennifer Payne
<br /> NAME:
<br /> Bryson Casualty Insurance Services Inc PHONE FAX
<br /> 3777 Long Beach Blvd (A/C,No,Ext):(562) 661-4723 (A/C,No):(562)435-5639
<br /> 5th Floor E-MAIL jpayne@brysonfinancial.com
<br /> Long Beach,CA 90807
<br /> INSURERS AFFORDING COVERAGE NAIC#
<br /> INSURER A:Steadfast Insurance Company 26387
<br /> INSURED INSURER B:Zurich American Insurance Company 16535
<br /> Ancon Marine INSURERC:
<br /> 10571 Los Alamitos Blvd. INSURERD:
<br /> Los Alamitos,CA 90720
<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 MWDD/YYYY MM/DD/YYYY
<br /> A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000
<br /> CLAIMS-MADE X OCCUR GPL 0831144-03 1/1/2026 1/1/2027 DAMAGE TO RENTED 1,000,000
<br /> X 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 $ 4,000,000
<br /> X 71 PRO-
<br /> POLICY LOC PRODUCTS-COMP/OP AGG $ 4,000,000
<br /> OTHER: PROF LIABILITY $ 2,000,000
<br /> B AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 5,000,000
<br /> Ea accident $
<br /> X ANY AUTO X X BAP 0125052-11 1/1/2026 1/1/2027 BODILY INJURY Perperson) $
<br /> OWNED SCHEDULED
<br /> AUTOS ONLY AUTOS BODILY INJURY Per accident $
<br /> HIRED NON-OWNED PROPERTY DAMAGE
<br /> AUTOS ONLY AUTOS ONLY Per accident)
<br /> ccident $
<br /> A X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 10,000,000
<br /> EXCESS LIAB CLAIMS-MADE SXS0831146-03 1/1/2026 1/1/2027 AGGREGATE $ 10,000,000
<br /> X DED RETENTION$ 0 $
<br /> B WORKERS COMPENSATION X PER OTH-
<br /> AND EMPLOYERS'LIABILITY STATUTE ER
<br /> Y/N X WC1052003-11 1/1/2026 1/1/2027 1,000,000
<br /> ANY PROPRIETOR/PARTNER/EXECUTIVE � N/A E.L.EACH ACCIDENT $
<br /> OFFICER/MEM BER EXCLUDED?
<br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,UOU
<br /> If yes,describe under 1,000,000
<br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $
<br /> A Pollution Liability GPL 0831144-03 1/1/2026 1/1/2027 7erOccurence 2,000,000
<br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached if more space is required)
<br /> City,its City Council,its officers,officials,employees,agents,and volunteers,where required by written agreement are to be covered as additional insureds,
<br /> under Consultant's CGL,Professional Liability,and Automobile Liability policies,with respect to any liability arising out of work or operations performed by
<br /> or on behalf of the Instructor including materials,parts,equipment,and personnel furnished in connection with such work or operations.Coverage is primary
<br /> and non-contributory.Waiver of Subrogation included.30 day notice of cancellation given*10 days for non-payment of premium
<br /> Tu Tran Digitally signed by
<br /> Tu Tran Nguyen
<br /> Date: -08121 APPROVED
<br /> Ng uyem4:36 11,,-0S'aa'
<br /> [By Tu Tran Nguyen at 2:35 pm,Dec 22,2025
<br /> CERTIFICATE HOLDER CANCELLATION
<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 /> Attn: Heidi Chou
<br /> 215 S.Center Street,M-85
<br /> Santa Ana,CA 92701 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
<br />
|