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79/5/2025
<br /> E(MM/DD/YYYY)
<br /> A�" CERTIFICATE OF LIABILITY INSURANCE
<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
<br /> NAME: Debbie Williams
<br /> HUB International Insurance Services Inc. PHONE FAX
<br /> PO Box 255387 A/C No Ext: 916-480-4124 A/C,No):916-993-7224
<br /> E-MSacramento CA 95865 ADDRESS: debbie.williams@hubinternational.com
<br /> INSURER(S)AFFORDING COVERAGE NAIC#
<br /> License#:0757776 INSURERA: Nautilus Insurance Company 17370
<br /> INSURED INTEDEM-01 INSURERB: Key Risk Insurance Company 10885
<br /> Interior Demolition Inc INSURERC: State Compensation Insurance Fund of California 35076
<br /> 23508 Pine Street
<br /> Newhall CA 91321 INSURERD:
<br /> INSURER E:
<br /> INSURER F:
<br /> COVERAGES CERTIFICATE NUMBER:24700283 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 TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS
<br /> LTR INSD WVD POLICY NUMBER MM/DD MM/DD
<br /> A X COMMERCIAL GENERAL LIABILITY Y Y ECP2035025-14 6/4/2025 6/4/2026 EACH OCCURRENCE $1,000,000
<br /> CLAIMS-MADE � OCCUR PREMISES DAMAGE TO
<br /> PREMISES Ea occurrence)
<br /> ccurrence $100,000
<br /> X $5,000 Ded/Occur MED EXP(Any one person) $5,000
<br /> PERSONAL&ADV INJURY $1,000,000
<br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000
<br /> POLICY� PECOT- LOC PRODUCTS-COMP/OP AGG $2,000,000
<br /> OTHER: $
<br /> B AUTOMOBILE LIABILITY Y Y BAP2035024-14 6/4/2025 6/4/2026 COMBINED SINGLE LIMIT $1,000,000
<br /> Ea accident
<br /> X ANY AUTO BODILY INJURY(Per person) $
<br /> OWNED SCHEDULED BODILY INJURY(Per accident) $
<br /> AUTOS ONLY AUTOS
<br /> HIRED NON-OWNED FIR ER DAMAGE $
<br /> AUTOS ONLY AUTOS ONLY Per accident
<br /> L $
<br /> A UMBRELLA LIAB X OCCUR FFX2035026-14 6/4/2025 6/4/2026 EACH OCCURRENCE $5,000,000
<br /> X EXCESS LAB CLAIMS-MADE AGGREGATE $5,000,000
<br /> DED X RETENTION$n $
<br /> C WORKERS COMPENSATION Y 1977624-24 9/27/2024 9/27/2025 X PER OTH-
<br /> AND EMPLOYERS'LIABILITY Y/N STATUTE ER
<br /> ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $1,000,000
<br /> OFFICE R/M EMBER EXCLUDED? ❑ N/A
<br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000,000
<br /> If yes,describe under
<br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000
<br /> A Professional Liability ECP2035025-14 6/4/2025 6/4/2026 Each Claim/Aggregate $1,000,000
<br /> Contractors Pollution Liability Each Occurrence/Agg. $1,000,000
<br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached if more space is required)
<br /> RE: 2520-City of Santa Ana-On Call Demo Services for Abatement Agreement
<br /> Additional Insured: City of Santa Ana, its officers,employees,agents and representatives are named as Additional Insureds with respect to General and Auto
<br /> Liability per the attached endorsements as required by written contract. Insurance is Primary and Non-Contributory. Waiver of Subrogation applies to Workers'
<br /> Compensation. Excess Liability extends over the Auto Liability, General Liability, Contractors Pollution Liability and Professional Liability. Policies provide for
<br /> 30 Days Notice of Cancellation,except 10 Days for Non-payment of Premium.
<br /> Forms: 10217 0714, BENVCA06 0917, CA0444 1013,CA0449 1116, ECP1220 0121, ECP1246 0121, ECP1248 0121, ECP1259 0121
<br /> CERTIFICATE HOLDER APPROVED CANCELLATION
<br /> By Tu Tran Nguyen at 11:26 am,Sep 08,2025
<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 /> Attn: Rocio De Leon-Molina Tu Tran Digitally by
<br /> Planningand Building Agency Tu Tran Nguyen
<br /> 9 9 Y Date:2025.09.09 AUTHORIZED REPRESENTATIVE
<br /> 20 Civic Center Plaza Nguyen 11'77'33-07'00'
<br /> Santa Ana CA 92701 ouaL__
<br /> ©1988-2015 ACORD CORPORATION. All rights reserved.
<br /> ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD
<br /> THIS CERTIFICATE SUPERSEDES PREVIOUSLY ISSUED CERTIFICATE
<br />
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