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ACQ® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD YYYY)
<br /> 9/5/2025
<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 Carl Davidson Insurance Agency
<br /> NAME:
<br /> Carl Davidson Insurance Agency PHONE (661)222-7319 FAX (661)222-7212
<br /> A/C No Ext: A/C,No:
<br /> 9700 Reseda Blvd Ste 106 E-MAIL carl@cdavidsoninsurance.com
<br /> ADDRESS:
<br /> Northridge,CA 91324 INSURER(S)AFFORDING COVERAGE NAIC#
<br /> INSURER A: Kinsale Insurance Company 38920
<br /> INSURED INSURER B: Infinity Select Insurance Company 20260
<br /> Vicon Enterprises Incorporated INSURER : State Fund 35076
<br /> 11642 Knott Avenue Unit#E20 INSURER D: Colony Insurance Company 39993
<br /> Garden Grove,CA 92841 INSURERE: Lexington Insurance Company 19437
<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 /> INS R ADDL SUBR POLICY EFF POLICY EXP
<br /> LTR TYPEOFINSURANCE INSD POLICYNUMBER MM/DD/YYYY MM/DDNYYY LIMITS
<br /> XCOMMERCIALGENERALLIABILITY EACH OCCURRENCE $ 1,000,000
<br /> DAMAGE TO RENTED 100 000
<br /> CLAIMS-MADE OCCUR PREMISES(Ea occurrence) $
<br /> XPollution MED EXP(Anyone person) $
<br /> A X X 0100160438-4 8/13/2025 8/13/2026 PERSONAL&ADV INJURY $
<br /> GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000
<br /> V PRO- 2,000,000
<br /> /\ POLICY JECT ❑ LOC PRODUCTS-COMP/OPAGG $
<br /> OTHER: $
<br /> AUTOMOBILELIABILITY COMBINED SINGLE LIMIT $ 1,000,000
<br /> (Ea accident)
<br /> XANYAUTO BODILY INJURY(Per person) $
<br /> B OWNED X SCHEDULED X X 50015564101 9/28/2025 9/28/2026 BODILY INJURY(Per accident) $
<br /> AUTOS ONLY AUTOS
<br /> HIRED NON-OWNED PROPERTY DAMAGE $
<br /> AUTOS ONLY AUTOS ONLY (Per accident)
<br /> UMBRELLALIAB X OCCUR EACH OCCURRENCE $ 5,000,000
<br /> A X EXCESS LAB CLAIMS-MADE X X 0100169118-4 8/13/2025 8/13/2026 AGGREGATE $
<br /> DED RETENTION $ $
<br /> WORKERS COMPENSATION X PER OTH-
<br /> AND EMPLOYERS'LIABILITY Y/N /\ STATUTE F ER
<br /> 1,000,000
<br /> C ANY CER/M MBRIPARTUDED7ECUTIVE � N/A X 9304121-25 8/21/2025 8/21/2026 E.L.EACH ACCIDENT $
<br /> OFFICER/MEMBER EXCLUDED?
<br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000
<br /> If yes,describe under 1 000,000
<br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $
<br /> Each Occurrence 5,000,000
<br /> Excess Liability(Occurrence)
<br /> D X X EX04281369 8/13/2025 8/13/2026
<br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
<br /> A Pollution Liability X X 0100160438-4 8/13/2025 8/13/2026 Each Occurence $1,000,000
<br /> E Professional Liability X X 015136312 10/23/2024 10/23/2025 Each Occurence $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 be primary,and any insurance carried by City shall be excess and noncontributory.30 days notice of cancellation
<br /> with 10 days notice for nonpayment of premium in accordance with the policy provisions.
<br /> Umbrella/Excess Liability coverage extends coverage over General Liability,Automobile Liability,Employer Liability and Professional Liability policies.
<br /> CERTIFICATE HOLDER CANCELLATION
<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 Center St,
<br /> Santa Ana,CA 92701701
<br /> ©1988-2015 ACORD CORPORATION. All rights reserved.
<br /> ACORD25(2016/03) The ACORD name and logo are registered marks of ACORD
<br /> APPROVED Tu Tran T.Tra lly signed by
<br /> Tu an Nguyen
<br /> By Tu Train Nguyen at 10:47 am,Sep 29,2025 Date:2025.09.29
<br /> Nguyen 10:47:29-07'00'
<br />
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