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,4 O® CERTIFICATE OF LIABILITY INSURANCE
<br />DATE/5/2D2�n
<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 pollcy(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 />Arthur J. Gallagher Risk Management Services, LLC
<br />Market Street
<br />Suite 2100
<br />San Francisco CA 94105
<br />CON
<br />PHONE 415-646-9300 AX
<br />A
<br />Ne:415-536-8499595
<br />ADDRESS,
<br />INSURER 8 AFFORDING COVERAGE
<br />NAIC If
<br />INSURERA: AXA XL Insurance Company UK Limited
<br />L'ce se , OD69293
<br />INSURED FIREAGE41
<br />Orange County Fire Authority
<br />P 0 Box 57115
<br />INSURER B: Safety National Casualty Corporation
<br />15105
<br />INSURER C:
<br />INSURER D:
<br />Irvine, CA 92619-7115
<br />INSURER E:
<br />INSURER F :
<br />COVERAGES CERTIFICATE NUMBER: 19940533 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
<br />LTR
<br />TYPE OF INSURANCE
<br />ADDL
<br />SUBR
<br />POLICY NUMBER
<br />POLICY EFF
<br />MMIDDIYYYY
<br />POLICY EXP
<br />MMIDD/YYYY
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />Y
<br />Y
<br />B1262RT0219724
<br />7H/2024
<br />7/1/2029
<br />EACH OCCURRENCE
<br />$1,600,000
<br />CLAIMS -MADE 1 OCCUR
<br />ET RE TEO
<br />PREMISES ERffg1T nenLO
<br />$
<br />MED EXP (Anyoneperson)
<br />$
<br />PERSONAL BADV INJURY
<br />$1,600,000
<br />AGGREGATE LIMIT APPLIES PER:
<br />GENERAL AGGREGATE
<br />$15,000,000
<br />GEN'L
<br />POLICY ❑ JECT PRO- ❑ LOC
<br />PRODUCTS -COMPIOP AGG
<br />$
<br />Public OrficialslEPL
<br />$1,500,000
<br />X
<br />OTHER: Annual
<br />A
<br />AUTOMOBILE
<br />LIABILITY
<br />Y
<br />Y
<br />B1262RT0219724
<br />7/1/2024
<br />7/1/2029
<br />COMBINEDSINGLE LIMIT
<br />Ea accident
<br />$1,500,000
<br />BODILY INJURY (Per person)
<br />$
<br />X
<br />ANY AUTO
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />BODILY INJURY (Per accident)
<br />$
<br />HIRED NON -OWNED
<br />AUTOS ONLY AUTOS ONLY
<br />PROPERTYDAMAGE
<br />Pe,..,dent
<br />$
<br />B
<br />UMBRELLA LIAR
<br />X
<br />OCCUR
<br />Y
<br />Y
<br />XPR4068288
<br />7/1/2024
<br />7/1/2025
<br />EACH OCCURRENCE
<br />$5,000,000
<br />AGGREGATE
<br />$5.000,000
<br />X
<br />EXCESS LIAR
<br />CLAIMS -MADE
<br />DIED I I RETENTION$
<br />$
<br />WORKERS COMPENSATION
<br />STATUTE
<br />EMPLOYERS' LIABILITY YIN
<br />STATUTE ER
<br />E.L. EACH ACCIDENT
<br />$
<br />ANYPROPRIETORIPARTNEWEXECUTIVE ❑
<br />OFFICERIMEMBEREXCLUDED9
<br />MIA
<br />E.L. DISEASE - EA EMPLOYEE
<br />$
<br />(Mandatory In NH)
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE -POLICY LIMIT
<br />$
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Addlllonal Remarks Schedule, maybe attached if more space Is required)
<br />RE: As -Needed Fleet Maintenance and Repairs Services
<br />ADDITIONAL INSURED(S): City of Santa Ana, its City Council, its officers, officials, employees, agents, and volunteers are to be covered as additional insureds
<br />with respect to liability an2l g out of work or operations performed by or on behalf of the Permittee Including materials, parts, equipment, and personnel
<br />furnished in connection with such work or operations.
<br />APPROVED
<br />By Tran Nguyen at 3:24 p% Feb 05, 20251
<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: Executive Director, Public Works Agency
<br />20 Civic Center Plaza, M-21 AU HORIZED REPRESENTATIVE
<br />Santa Ana CA 92701 n�?, ,
<br />©1988-2015 ACORD CORPORATION. All rinhfe
<br />ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD DlgRanysignad by Tu
<br />THIS CERTIFICATE SUPERSEDES PREVIOUSLY ISSUED CERTIFICATE Tu Tran -. Tran Nguyen
<br />Nguyen Daetca3025,02.0515:25:02
<br />
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