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ACORO® CERTIFICATE OF LIABILITY INSURANCE
<br />DATE(MMIDDmYY)
<br />1
<br />L�
<br />02/04/2025
<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
<br />CONTACT Shelby Cecena AFIS
<br />NAME:
<br />James G Parker Insurance Assoc
<br />PHONE (559) 584-3323 FAX (559 5849313
<br />AlC No Eat : Na :
<br />License #0554959
<br />E-MAIL shelbyc@jgparker.com
<br />ADDRESS:
<br />P O Box 1129
<br />INSURERS AFFORDING COVERAGE
<br />NAIC #
<br />INSURER A: Landmark American Ins Cc
<br />33138
<br />Hanford CA 93232
<br />INSURED
<br />INSURER B: National Specialty Insurance Cc
<br />22608
<br />Baker Rescue Services Inc
<br />INSURER C: State Compensation Ins Fund
<br />35076
<br />19744 Beach Blvd #366
<br />INSURER D:
<br />INSURER E:
<br />Huntington Beach CA 92648-2988
<br />INSURER,:
<br />COVERAGES CERTIFICATE NUMBER: 24-25 Master GL/BAIWCI REVISION NUMBER:
<br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOWHAVE BEEN ISSUED 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 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 />ADOL5UBR
<br />INSD
<br />MID
<br />POLICYNUMBER
<br />POLICYEFF
<br />MMIDD/YYYY
<br />POLICY EXP
<br />MMIDDNYYY
<br />LIMITS
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE 7x OCCUR
<br />EACH OCCURRENCE
<br />S 11000,000
<br />PREMISES (E.occrmamad
<br />$ 50.000
<br />MEDEXP(Any.r.,mon
<br />$ 5,000
<br />PERSONAL a ADV INJURY
<br />$ 1,000,000
<br />A
<br />Y
<br />Y
<br />LHC860014
<br />08/03/2024
<br />08/03/2025
<br />GEN'L AGGREGATE LIMITAPPLIES PER:
<br />POLICY E PROJECT- ElLOC
<br />GENERALAGGREGATE
<br />$ 2,000,000
<br />PRODUCTS-COMP/OPAGG
<br />$ 2,000,000
<br />CGL 8 Professional Liab
<br />s 2,000,000
<br />OTHER:
<br />AUTOMOBILE
<br />LIABILITY
<br />COMBiNEOSINGLE LIMIT
<br />Ea accitlent
<br />$ 1,000,000
<br />BODILY INJURY (Per person)
<br />$
<br />ANYAUTO
<br />B
<br />OWNED SCHEDULED
<br />AUTOS ONLY X AUTO$
<br />Y
<br />Y
<br />GM1060601
<br />08/03/2024
<br />08/03/2025
<br />90DILY INJURY(Per acciaen0
<br />$
<br />HIREp NON -OWNED
<br />AUTOS ONLY AUTOS ONLY
<br />PROPERTY DAMAGE
<br />Per acdtlent
<br />$
<br />Uninsured motorist
<br />s 1,000,000
<br />UMBRELLALIAB
<br />OCCUR
<br />��•••�•,"�� y""""
<br />EACH OCCURRENCE
<br />$ 5.000,000
<br />AGGREGATE
<br />$ 5,000,000
<br />A
<br />EXCESS LIAR
<br />CLAIMS -MADE
<br />LHA602060
<br />08/03/2024
<br />08/03/2025
<br />OED
<br />RETENTION 8
<br />$
<br />C
<br />WORKERS COMPENSATION
<br />AND EMPLOYERV LIABILITY YIN
<br />ANY PROPRIETORPARTNER1EXE11IVE
<br />OFFICEILMEMBER EXCLUDED?
<br />(Mandatory in NH)
<br />Rescribe yes, tlunder
<br />DESCRIPTION OF OPERATIONS below
<br />N/A
<br />Y
<br />1851446-2024
<br />09/01/2024
<br />09/01/2025
<br />SPER OTH-
<br />TAT UTE ER
<br />E.L. EACH ACCIDENT
<br />$ 1,000,000
<br />E.L. DISEASE - EA EMPLOYEE
<br />$ 1,000,000
<br />E.L. DISEASE - POLICY LIMIT
<br />$ 1,000,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101. Additional Remarks Schedule, may be ed cbed if more space Is required)
<br />City of Santa Ana, its City Council, its officers, officials, employees, agents, and volunteers are included as Additional Insured with respects to General
<br />Liability per attached form RSG95001 0903 and Automobile Liability per attached form CA2048 1013. Primary 8 Non-contributory is included with respects to
<br />General Liability per attached form RSG54155 0816. Wavier of Subrogation Applies with respects to General liability, Automobile liability and Workers
<br />Compensation per attached forms RSG54078 0310, CA04441013 810217 REV4-2018.
<br />APPROVED
<br />By To Tran Nguyen at 11:08 am, Feb 04, 2025
<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
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />ATTN: Water Resources
<br />AUTHORIZED REPRESENTATIVE
<br />215 S. Center St
<br />Santa Ana CA 92703
<br />j
<br />_ o � 1.1/
<br />@ 1988-2015 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD Tu Tran Digitally signed by Tu
<br />Tran Nguyen
<br />Nguyen DF0914�08'00'4
<br />
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