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ACORO� CERTIFICATE OF LIABILITY INSURANCE
<br />F DATE(MMIODNYYY)
<br />1 03/17/2025
<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 NAME: Tina Cowie
<br />Cornerstone Specially Insurance Services, Inc.
<br />PHONE (714) 731-7700 FAX (714) 731-7750
<br />Ext : A/C, No
<br />ikr�ina@cornerstonespecialty.com
<br />14252 Culver Drive, A299
<br />p0oRlEss: tina@cornerstonespeclalty.com
<br />INSURER(S) AFFORDING COVERAGE
<br />NAICIf
<br />]Nine CA 92604
<br />INSURERA: Valley Forge Insurance Company
<br />20508
<br />INSURED
<br />INSURER B: The Continental Insurance Company
<br />20444
<br />JIG CONSULTANTS
<br />INSURERC: Continental Casualty Company
<br />20443
<br />318 W. Katella Ave.
<br />INSURER D: Travelers Casualty8 Surety Co. ofAmerica
<br />31194
<br />Ste A
<br />INSURER
<br />Orange CA 92867
<br />INSURER FE:
<br />COVERAGES CERTIFICATE NUMBER: 24125 COVERAGES REVISION NUMBER -
<br />THIS IS TO CERTIFY THATTHE 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
<br />CERTIFICATE MAYBE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECTTO ALL THE TERMS,
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />INSR
<br />LT0.
<br />TYPE OFINSURANCE
<br />INSD
<br />MO
<br />POLICY NUMBER
<br />P LICY EFF
<br />MMIDD
<br />POLICY EXP
<br />MMIDD
<br />LIMITS
<br />X
<br />COMMERCIAL GENERALLIABILITY
<br />CLAIMS -MADE OCCUR
<br />ADDTL INSURED / P 8 NC
<br />EACH OIAMAGCCURRENCE
<br />$ 2,000,000
<br />UI
<br />PREMISES Ea occurrence
<br />$ 1,000,000
<br />x
<br />MED EXP (Any one person
<br />$ 10,000
<br />x
<br />BLNKTWVROFSUBRO
<br />PERSONAL B ADV INJURY
<br />$ 2,000,000
<br />A
<br />6021640522
<br />09/01/2024
<br />09/01/2025
<br />GEN'LAGGREGATE
<br />LIMITAPPLIES PER
<br />POLICY JECT LOC
<br />GENERALAGGREGATE
<br />$ 4,000,000
<br />PRODUCTS-COMPIOPAGG
<br />$ 4,000,000
<br />$
<br />OTHER'
<br />AUTOMOBILE
<br />LIABILITY
<br />ANYAUTO
<br />COMBINED SINGLE LIMIT
<br />Its accident
<br />$ 1,000,000
<br />X
<br />BODILY INJURY (Per person)
<br />$
<br />B
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />7038807240
<br />09/01/2024
<br />09/01/2025
<br />BODILYINJURY(Per accident)
<br />$
<br />HIRED NON -OWNED
<br />AUTOS ONLY AUTOS ONLY
<br />PROPERTY -DAMAGE
<br />Per accident
<br />$
<br />$
<br />X
<br />UMBRELLA LIAR
<br />V
<br />^OCCUR
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />C
<br />EXCESSLIAB
<br />CLAIMS -MADE
<br />7034600658
<br />09/01/2024
<br />09/01/2025
<br />AGGREGATE
<br />$ 1,000,000
<br />DED
<br />X RETENTION $ 10,000
<br />S
<br />A
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY YIN
<br />ANY PROPRIETORIPARTNERIEXECUTIVE
<br />OFFICERIMEMBER EXCLUDED?
<br />NIA
<br />7013360534
<br />09/01/2024
<br />09/01/2025
<br />PER
<br />X STATUTE ERH
<br />EL EACH ACCIDENT
<br />$ 1,000,000
<br />E.L. DISEASE - EA EMPLOYEE
<br />S 1,000,000
<br />(Mandatory In NH)
<br />If yes, describe antler
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE -POLICY LIMIT
<br />$ 1,000,000
<br />D
<br />Professional Liability
<br />Claims Made$4,000,000
<br />107683694
<br />09/01/2024
<br />09/01/2025
<br />Each Claim
<br />AnnualAggregate
<br />$2,000,000
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached H more space Is required)
<br />General Liability policy excludes claims arising out of the performance of professional services. The City of Santa Ana, its officers, Officials, employees,
<br />agents, and volunteers are Additional Insured for General Liability but only if required by written contract with the Named Insured prior to an occurrence and
<br />as per attached endorsement. Coverage is subject to all policy terms and conditions. *30 days notice of cancellation, except for 10 days notice for
<br />non-payment of premium. For Professional Liability coverage, the aggregate limit is the total insurance available for all Covered claims reported within the
<br />policy period.
<br />Tu Tran DigitaTUTralllysignened by APPROVED
<br />Dam:2025.03.19
<br />N u en n oo:3?-orao By Tu Tran Nguyen at 11:00 am, Mar 19, 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 Attention: Public Works Agency ACCORDANCE WITH THE POLICY PROVISIONS.
<br />20 Civic Center Plaza (M-21)
<br />AUTHORIZED REPRESENTATIVE n
<br />Santa Ana CA 92701
<br />U 1938-2915 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
<br />
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