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Ac"R & CERTIFICATE OF LIABILITY INSURANCE <br />DATE l2M8M;12D�DfY Y) <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 Tights to the certificate holder in lieu of such endorsement(s). <br />PRODUCER <br />AssureclPartners Design Professionals Insurance Services, LLC <br />3697 Mt. Diablo Blvd Suite 230 <br />Lafayette CA 94549 <br />CONTACT <br />NAME: Lisa Shimizu-Fookes <br />PHONE 7141127-3482 FAX <br />Arc Na <br />E-MAIL <br />D- DREss: CertsDes i nPro AssuredPartners.com <br />INSURERIS) AFFORDING COVERAGE <br />NAIC # <br />INSURER A: XL Specialty Insurance Co. <br />37885 <br />License#: 6003745 <br />INSURED PSOMASO-01 <br />PSOMAS <br />INSURER B : <br />865 S. Figueroa Street, Suite 3200 <br />INSURERC: <br />INSURER D : <br />Los Angeles CA 90017 <br />INSURER E : <br />INSURER F : <br />COVERAGES CERTIFICATE NUMBER: 1586487023 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 GLAIMS. <br />INSR <br />LTR <br />TYPE OF INSURANCE <br />ADDL <br />SUBR <br />POLICY NUMBER <br />POLICY EFF <br />MMIDDlYYYYI <br />POLICY EXP <br />(MMIDDfYYYYI <br />LIMITS <br />COMMERCIAL GENERAL LIABILITY <br />CLAIMS -MADE D OCCUR <br />EACH OCCURRENCE <br />$ <br />DAMAGES (RENTED <br />PREMISES Ea occurrence) <br />$ <br />MED EXP (Any one person) <br />$ <br />PERSONAL & ADV INJURY <br />5 <br />AGGREGATE LIMIT APPLIES PER: <br />POLICY D PRO- <br />JECT J LOC <br />GENERAL AGGREGATE <br />5 <br />GEN'L <br />PRODUCTS -COMPIOPAGG <br />S <br />5 <br />OTHER: <br />AUTOMOBILE <br />LIABILITY <br />COMBINED SINGLE LIMIT <br />Ea accident <br />S <br />BODILY INJURY (Per person) <br />5 <br />ANY AUTO <br />OWNED SCHEDULED <br />AUTOS ONLY AUTOS <br />BODILY INJURY (Per accident) <br />5 <br />HIRED NON -OWNED <br />AUTOS ONLY AUTOS ONLY <br />PROPERTY DAMAGE <br />Per accident)5 <br />5 <br />UMBRELLALIAB <br />OCCUR <br />EACH OCCURRENCE <br />$ <br />AGGREGATE <br />$ <br />EXCESS LIAR <br />CLAIMS -MADE <br />DIED I I RETENTIONS <br />$ <br />WORKERS COMPENSATION <br />PER OTH- <br />AND EMPLOYERS' LIABILITY Y d N <br />STATUTE ER <br />E.LEACH ACCIDENT <br />$ <br />ANYPROPRIETORIPARTNERIEXECUTIVE <br />OFFICE RIMEMBEREXCLUDED? <br />NdA <br />E.L. DISEASE - EA EMPLOYEE <br />$ <br />(Mandatory in Ni <br />If yes, describe under <br />E.L. DISEASE - POLICY LIMIT <br />s <br />DESCRIPTION OF OPERATIONS below <br />A <br />Professional Lill & Poll. Liab <br />Claims -Made Form <br />Retro Date: 10/1511947 <br />Y <br />DPR5033899 <br />10/15/2024 <br />10/15/2025 <br />Per Claim <br />Aggregate Limit <br />$2,000,000 <br />$2,000,000 <br />DESCRIPTION OF OPERATIONS I LOCATIONS f VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) <br />Additional Insured Status is not available on Professional Liability Policy. <br />3SAN050200 - Santa Ana Environmental and Planning Services, Santa Ana, CA. <br />Insurance coverage includes waiver of subrogation per the attached endorsement. <br />CERTIFICATE HOLDER CANCELLATION 30 Day Notice of Cancellation <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF- NOTICE WILL BF ❑SLIVERED IN <br />ACCORDANCE WITH THE POLICY Pi <br />City of Santa Ana o R!Kk MovigmedDi <br />20 Civic Center Plaza Santa Ana CA 92701 AUTHORIZED REPRESENTATIVE REVIEWED&APPROVEDRY: <br />Risk Management Spedalist <br />©1988-2015 ACORD <br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD <br />