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11
<br /> ADO I CERTIFICATE OF LIABILITY INSURANCE DATE`MMMDNYYY)
<br /> V 1 1102024
<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 AM END,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
<br /> BELOW, THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE 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 Carl Davidson Insurance Agency
<br /> NAME:
<br /> Carl Davidson Insurance Agency PHONE (661)222-7319 Fwl (661)222-7212
<br /> NC No Ext: AtC,Nq
<br /> 25060AvenueStanfordSte.270 E-MAIL carl(acdavidsoninsurance.com
<br /> ADDRESS:
<br /> Valencin,CA 91355 IHSURER(S)AFFORDING COVERAGE NMCa
<br /> INSURERA: Kinsale Insurance Company 38920
<br /> INSURED INSURERS: Infinity Select Insurance Company 20260
<br /> icon Enterprises Incorporated INSURER C:
<br /> 11642 Knott Avenue Unit#1r20 INSURERD: State Fund 35076
<br /> Garden Grave,CA 92841 INSURERE: Colony Insurance Company 39993
<br /> INSURERF: Lexington Insurance Company 19437
<br /> COVERAGES CERTIFICATE NUM DER: REVISION NUM BM-
<br /> THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN 155UED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
<br /> INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
<br /> CERTIFICATE MAYBE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLfCIES DESCRIBED HEREIN IS SUBJECTTO ALL THE TERMS.
<br /> EXCLUSIONS AND CONDITIONS OF SUCH POLICIES_LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br /> INSIR A13DL SUBR POLICYEFF POLICY EXP
<br /> LTR TYPE OFINSURANCE INSD POLICY NUMSER MMIOONYYY] IMMODNYYYt LIMITS
<br /> XCOMMEnciAL GENERAL LIABILITY EACH OCCURRENCE 5 1.000,000
<br /> DAMAGE TO RE 7F1T
<br /> CLAIMS-MAOE , OCCUR PREMLSES(Eaaec,ure„cej 5 100,000
<br /> MED EXP(Any—person) 5
<br /> X X 0100160438-3 B/1312024 8/13/2025 PERSONAL&ADVINJURY 5
<br /> ��G//EN'L AGGREGATE LIMIT APPLIES PER GENERALAGGREGATE S 2,000,000
<br /> PODCY jERa LOG PRODUCTS-COMPUPAGG s 2,000,000
<br /> OTHER S
<br /> ADTOMOBILELUU3 ILITY COMMNED SINGLE LIMIT S 1,000,000
<br /> (Ea accide tl
<br /> ANYAUTO EOBILY INJURY(Perp--) S
<br /> g A�ONLY ED -7 SCHEDULEDX X 50015564101 912812024 9/2612025 BODILY INJURY(Per acr:idenl) S
<br /> AUTOS
<br /> HIRED NON-OVVNED PROPERTY DAMAGE S
<br /> AUTOSONLY AUTOS ONLY (Per eccide,dl
<br /> S
<br /> UMaRELLA LIAn X OCCUR EACH OCCURRENCE S 5,000,000
<br /> A A EXCESS LIPS CLAIMS-MADE X X a1a0169118d 8/13/2024 8/13/2025 AGGREGATE S
<br /> DED I I RETENTION S S
<br /> W URKERS COMPENSATION if PER
<br /> UI OTH-
<br /> AND EMPLOYERS'LBILITY /� STATUTE ER
<br /> ANY PROPRIETORfPARTNERfEXECUTIVE YIN 1,000,000
<br /> D OFFICERUFMRER EXCLUDED7 � NIA X 9304121-24 8/21/2024 8/21/2025 EL.EACH ACCIDENT S
<br /> {Mandatary In NHl ELL DISEASE-EA EMPLOYEE S 1,aoa,aaa
<br /> Il�,descri�uMer
<br /> DESCRIPTION OF OPERATIONS haft- El.DISEASE-PCDCYUMIT S 1,000,00a
<br /> Excess liability(Occurrence)
<br /> E X X EX04381369-2 8113I2024 8113/2025 Each Occurrence 5,000,009
<br /> DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD InI.ArIftonal Remains Schedule,maybe attached U more space is required)
<br /> A POLLUTION LIABILITY X X 0100160438-3 8/13/2024 S/l3/2025 Each Occurrence: $1,000,000
<br /> F PROFESSIONAL L.LIBILITY X X 015136312 10/2312024 10/23/2025 Each Occurrence: $2,000,000
<br /> City of Santa Ana,officers,agents,employees,and volunteers are named as additionally insured on this policy pursuant to written contract,agreement,or memorandum of
<br /> understanding.Such insurance as is afforded by this policy shall he primary,and any insurance carried by City shall be excess and noncontributory.30 days notice afcancellation
<br /> with 10 days notice for nonpayment of premium in accordance with the policy provisions.
<br /> —IlmhrellafExcess Liability coverage extends coverage over General Liability,Automobile Liability,Employer Liability and Professional Liability policies—
<br /> CERT IFIC ATE HOLDER CANCELLATION
<br /> SHOULD ANYOF THE ABOVE DESCRIBED POLICIES BF CANCELLED BEFORE
<br /> THE EXPIRATION DATE THEREOF,NOTICE W ILL BE DELIVERED IN
<br /> (7i ty of Santa Ana ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> Risk Management Division
<br /> 20 Civic n,CA92702
<br /> enter Plaza
<br /> Santa Ana,CA92702
<br /> C�1988-2019 ACORD CORPORATION. All rights reserved,
<br /> ACORD 25(2016l03) The ACORD name and logo are registered marks of ACORD
<br /> APPROVED
<br /> By Cynthia Mara at 8:29 am, Nov 26, 2024
<br />
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