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4LEAINC-01 MINEDI
<br /> ,d►��RO CERTIFICATE OF LIABILITY INSURANCE DATDlYYYY)
<br /> 3/18/218/2025
<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 License!f OC41366 CONTACT
<br /> NAME:
<br /> Granite Professional Insurance Brokerage,Inc. (A//C,N,Ext):(925)462-8400 jac,No):(925)462-8888
<br /> 360 Lindbergh Avenue
<br /> Livermore,CA 94551 E-MAIL li commerca
<br /> ADDRESS: @graniteins.com
<br /> INSURERS AFFORDING COVERAGE NAIC#
<br /> INSURER A:Travelers Property Casualty Company of America 25674
<br /> INSURED INSURER B:Travelers IndemnityCompany of Connecticut 25682
<br /> 4LEAF,Inc. INSURER C:Berkshire Hathaway Homestate 20044
<br /> 2126 Rheem Dr INSURER D:HDI Global Specialty SE
<br /> Pleasanton,CA 94588
<br /> INSURER E:
<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 /> ILT R I TypE OF INSURANCE ADOL SUER POLICY NUMBER POLICY EFF POLICY EXP
<br /> L D IDD M D LIMITS
<br /> A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 1,000,000
<br /> CLAIMS-MADE X OCCUR 6806XG31656 3/15/2025 3/1512026 DAMAGE TO RENTED 1,000,000
<br /> X X PREMISES Ea occurrence S
<br /> MED EXP(Any oneperson) S 5,000
<br /> PERSONAL&ADV INJURY S 1,000,000
<br /> GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000
<br /> POLICY[XJ JECT 7 LOG PRODUCTS-COMP/OP AGG S 2,000,000
<br /> OTHER,
<br /> S
<br /> B AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000
<br /> Ea accident S
<br /> X ANY AUTO X X BA6X632782 3/15/2025 3/1512026 BODILY INJURY Per person) S
<br /> OWNED SCHEDULED
<br /> AUTOS ONLY AUTOS BODILY INJURY Per accident S
<br /> X HIRED X NON-OWNED PROPERTY DAMAGE
<br /> AUTOS ONLY AUTOS ONLY Per accident $
<br /> I
<br /> $
<br /> A X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 6,000,000
<br /> EXCESS LIAB CLAIMS-MADE CUP6X635599 3/15/2025 3/15/2026 AGGREGATE $ 6,000,000
<br /> DED 1 X I RETENTIONS 0 $
<br /> C WORKERS COMPENSATION X PER OTH-
<br /> AND EMPLOYERS'LIABILITY STAT
<br /> YIN LITEER
<br /> ANY PROPRIETOR/PARTNER/EXECUTIVE X FOWC623693 3l15l2025 3/15/2026 1,000 000
<br /> E.L.EACH ACCIDENT
<br /> OFFICERIMEMBER EXCLUDED? F7 N/A
<br /> $
<br /> (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE S 1,000,000
<br /> If yes,describe under 1,000,000
<br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S
<br /> D Professional Liab X FRS-H-P-PL-00012109-01 3/1512025 3/15/2026 Each Claim 2,000,000
<br /> D FRS-H-P-PL-00012109-01 3/15/2025 3/15/2026 Aggregate 2,000,000
<br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule may be attached if more space is required)
<br /> The attached forms apply as required per written contract or written agreements between the listed parties and the Insured,which are subject to the policy
<br /> provisions.In the absence of such written contract or written agreement the attached form may not be applicable.
<br /> City of Santa Ana,its City Council,officers,officials,employees,agents,and volunteers are Additional Insured on General Liability policy and Automobile
<br /> Liability policies per attached endorsements CG D3 81 09 15 and CA T3 53 02 15. General Liability is Primary and Non-Contributory per Form CG D3 81 09 15.
<br /> Waivers of Subrogation apply to General Liability,Automobile Liability,Workers Compensation and Professional Liability Policies per attached endorsements
<br /> CG D3 81 09 15,CA T3 53 02 15,WC 99 04 10 C and AE POL 90001 MU 05 24. 30 Day Notice of Cancellation applies on Workers'Compensation and General
<br /> Liability policies.
<br /> CERTIFICATE HOLDER APPROVED CANCELLATION
<br /> By Tu Tran Nguyen at 10:35 am,Mar 21,2025
<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 ogaany,g ed ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> Planning and Building Agency Tu Tran by TLTm
<br /> N
<br /> 20 Civic Center Plaza Nguyen gateguyen 2025.03,21
<br /> Santa Ana,CA 92701 10:35 45-0200 AUTHORIZED REPRESENTATIVE
<br /> ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved.
<br /> The ACORD name and logo are registered marks of ACORD
<br />
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