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JLEEENG-01 MICHAELA
<br /> CERTIFICATE OF LIABILITY INSURANCE DATDIYYYY)
<br /> 8122122212024
<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#OE67768 CONTACT Andr,o ' hiel
<br /> NAME:
<br /> IOA Insurance Services PHONE
<br /> 3875 Hopyard Road (A/C,No,Ext):(9.5)2 nah sionea bv--
<br /> Suite 200 Angie
<br /> ADDRESS:
<br /> E-MAIL Andn,3.Michae @ioausa. om
<br /> Pleasanton,CA 94588 NS GAwsox NAIC#
<br /> INSURER A:RLI In:urance impany 13056
<br /> INSURED INSURER B:A'A In -�-Q—� 1150
<br /> JLee Engineering,Inc. RER C: _ L •v .v
<br /> 430 S.Garfield Ave nu 1�e v e INs ER D
<br /> Alhambra,CA 91801
<br /> '. F c
<br /> �!NI''!R 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 /> INSR LTRTYPE OF INSURANCE ADDINSDL SUBDR POLICY NUMBER POLICY EFF POLICY EXP LIMITS
<br /> A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000
<br /> CLAIMS-MADE FX] OCCUR PSBOO10319 9/1/2024 9/1/2025 DAMAGE TO RENTED 1,000,000
<br /> PREMIS S Eacccurc nce S
<br /> MED EXP(Any oneperson) S 10,000
<br /> PERSONAL&ADV INJURY $ 2,000,000
<br /> GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 4,000,000
<br /> POLICY� JPECOT LOC PRODUCTS-DOMPIOPAGG S 4,000,000
<br /> OTHER: s
<br /> A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000
<br /> Ea accide t $
<br /> X ANY AUTO PSA0003335 9/112024 9/112025 BODILY INJURY fPerperson) S
<br /> OWNED SCHEDULED
<br /> AUTOS ONLY AUTOS BODILY INJURY fPer accident S
<br /> X HIRED X NON-OWNED PROPERTY DAMAGE
<br /> AUTOS ONLY AUTOS ONLY Per accident S
<br /> S
<br /> UMBRELLA LIAB OCCUR EACH OCCURRENCE S
<br /> EXCESS LIAB CLAIMS-MADE AGGREGATE 5
<br /> DED RETENTIONS $
<br /> A AND EMPLOYERS LIIABILIITNY X STATUTE OTH-
<br /> ANYPROPRIETOR/PARTNER/EXECUTIVE YIN PSW0005581 911/2024 911/2025 1,000,000
<br /> OFFICERIMEMBER EXCLUDED? N/A E.L.EACH ACCIDENT $
<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 $
<br /> B Professional Liab. PAAEP00102506 9/1/2024 9/1/2025 Per Claim 2,000,000
<br /> B Professional Liab. PAAEP00102506 9/112024 9/1/2025 Aggregate 2,000,000
<br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
<br /> All Operations of the Named Insured.
<br /> "Effective 1212112022,Professional Liability increased to$2,000,000 per claim and$2,000,000 aggregate.
<br /> General Liability:See Additional Insured Endorsement attached;such coverage is Primary&Non-Contributory with Separation of Insureds and Waiver of
<br /> Subrogation included,as required by written contract.
<br /> NOTE: No company-owned vehicles.General Liablity includes coverage for Hired&Non-Owned Auto Liability.
<br /> Workers'Compensation:Please see attached Waiver of Subrogation Endorsement,as required by written contract.
<br /> SEE ATTACHED ACORD 101
<br /> CERTIFICATE HOLDER CANCELLATION
<br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCFLLED BEFORE
<br /> THE EXPIRATION DATE THEREO
<br /> ACCORDANCE WITH THE POLICY PR( �o f Risk Mougmed DlMsbn
<br /> 3
<br /> 4+ REVIEWED&APPROVED BY:
<br /> City of Santa Ana AUTHORIZED REPRESENTATIVE
<br /> Risk Management Division j� A AcWFa�a
<br /> 20 Civic Center Plaza,4th Floor Risk Management Specialist
<br /> ISanta Ana.CA 92701
<br /> ACORD 25(2016103) v ©1988-2015 ACORD CORPORATION. All rights reserved.
<br /> The ACORD name and logo are registered marks of ACORD
<br />
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