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ACC)RL> CERTIFICATE OF LIABILITY INSURANCE UATE(MMI025rrY)
<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 C1=RTIFICATE HOLDER.
<br /> IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the pollcy(€es) 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 Gndorsement(s).
<br /> PRODUCER CONTACT
<br /> NAME:
<br /> PHONE 8B8)780-5381 FAIL No; 866)828-2424
<br /> WTW MIDWEST INC AIL
<br /> ADDRESS: Cerlif€cafe@Hanover.com
<br /> 233 S WACKER DR,SUITE 2000 INSURERS AFFORDING COVERAGE NAIC 0
<br /> CHICAGO IL 60606 INSURER A: Citizens Ins Co of America 31534
<br /> INSURED INSURER B: Hanover Insurance Co 22292
<br /> INSURER C: Hanover American Ins Cc 36064
<br /> BUCKNAM INFRASTRUCTURE GROUP INC INSURERD:
<br /> 3548 SEAGATE WAY STE 230 INSURER E:
<br /> OCEANSIDE CA 92056 INSURERF:
<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 /> INSR ADDL SUER POLICY EFF POLICY EXP
<br /> LTR TYPE OF INSURANCE POLICY NUMBER MMIDD MMIDDIYYYY LIMITS
<br /> y/ COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000
<br /> CLAIMS-MADE DAMAGE TO RENTC=D OCCUR PREMISES Ea occurrence $ 1,000,000
<br /> MED EXP(Any one person) $ 10,000
<br /> A Y Y OBCA39995610 0911612024 09116I2025 PERSONAL&ADVlNJURY $ 2,000,000
<br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 4,000,000
<br /> POLICY[V]JECT ❑LOC PRODUCTS-COMP/OP AGO $ 4,000,000
<br /> OTHER: $
<br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
<br /> Ea accdent $ 2,000,000
<br /> ANY AUTO BODILY INJURY(Per person) $
<br /> A OWNED SCHEDULED Y Y 0BC A399956 10 09/16/2024 09/16/2025 BODILY INJURY Per accident) $
<br /> AUTOS ONLY AUTOS
<br /> JHIRED NON-OWNED PROPERTY DAMAGE
<br /> AUTOS ONLY AUTOS ONLY Aer awldenl $
<br /> J UMBRELLA LIAB y OCCUR EACH OCCURRENCE $ 6,000,000
<br /> A EXCESS LIAB CLAIMS-MADE Y Y OBC A399956 10 09/16/2024 09/16/2025 AGGREGATE $ 6,000,000
<br /> ❑ED RETENTION$ $
<br /> WORKERS COMPENSATION / PER OTH-
<br /> AND EMPLOYERS'LIABILITY YIN V STATUTE; ER
<br /> ANYPC OFF C@RlMEMBEREXCLU Eb7 ECUTIVE � NIA Y WZC A399946 10 09/16/2024 09/16/2025 E.L.EACH ACCIDENT $ 1,000,000
<br /> €Mandatory In NMI E.L.DISEASE-EA EMPLOYEE $ 1,000,000
<br /> If yes,dosodhe under
<br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1$ 1,000,000
<br /> B Architects&Engineers Prof Liab N Y LHC H023717 05 09/16/2024 09/16/2025 Claims-Made:$21V Ea Cla€ml$2M Agg
<br /> DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space is required)
<br /> City of Santa Ana,Its City Council,Its Officers,officials,employees,agents,and volunteers are Additional Insured on the General Liability and Auto Liabilitypursuant to the
<br /> terms and conditions by form 391-1586.Additional Insured is Primary and Noncontributory to the extent provided by form 391-1003(pg 79 of 81).Separation of Insureds
<br /> provided to the extent allowed by form 391-1003(pg 73 of 81).Waiver of Subrogation as provided by form 391-1003(pg 80 of 81),WC040306,and 921-1001 (pg 15 of
<br /> 17).Cancellation Notice will be provided to the Certificate Holder pursuant to endorsement:401-1235.Such notice is solely for the purpose of informing the Certificate
<br /> Holder of the effective date of cancellation and does not grant,alter,or extend any rights or obligations under this policy,
<br /> TU Tran Digita.TuT alnNguy Nly signed guyen APPROVED
<br /> b te;2025.04.22
<br /> Nguyen' 1,:ae:22-oro, By Tu Tran Nguyen at 11.05 am,Apr--22,2025
<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 /> ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> CITY OF SANTA ANA
<br /> ATTN:HAYLEY GIL13ERT AUTHORIZED REPRESENTATIVE
<br /> 20 CIVIC CENTER PLAZA M-36
<br /> SANTA ANA CA 92701
<br /> @ 1988-2015 ACORD CORPORATION. All rights reserved.
<br /> ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD
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