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Last modified
5/20/2025 2:15:39 PM
Creation date
5/20/2025 2:09:57 PM
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Contracts
Company Name
PSOMAS
Contract #
A-2025-018-07
Agency
Public Works
Council Approval Date
2/18/2025
Expiration Date
2/17/2028
Insurance Exp Date
4/1/2026
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ACCAW CERTIFICATE OF LIABILITY INSURANCE <br />DATE(MMIUD/VYYY) <br />111111� <br />4/1/2025 <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 />Ed ewood Partners Insurance Agency <br />9 9 y <br />3780 Mansell Rd. Suite 370 <br />Alpharetta GA 30022 <br />CONTACT <br />HAME: Gre lin COI Specialist <br />PNONE 770.756.6599 FAA/c Ho..770.756.6599 <br />E-MAIL <br />ADDRESS: 2 lin certs re lin .com <br />INSURERS AFFORDING COVERAGE <br />NAIC# <br />INSURER A: National Union Fire Ins CO Of Pittsburg19445 <br />INSURED <br />Psomas <br />INSURER B : <br />INSURERC: <br />865 South Figueroa Street <br />Suite 3200 <br />Los Angeles CA 90017 <br />INSURER D: <br />INSURER E <br />INBURER F: <br />COVERAGES CERTIFICATE NUMBER: 510446064 RPVISIflN A1111MRClo• <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 <br />LTR <br />TYPE OF INSURANCE <br />AODL <br />SUER <br />POLICY NUMBER <br />POLICY EFF <br />MMND <br />POLICY EXP <br />MM/DD/YYVY <br />LIMITS <br />A <br />X <br />COMMERCIAL GENERAL LIABILITY <br />CLAIMS -MADE OCCUR <br />GL5268212 <br />4/1/2025 <br />4/1/2026 <br />EACH OCCURRENCEED <br />$2,000,000 <br />DAMAGE TO RENT <br />PREMISES Ea occurrence <br />$500,000 <br />MED EXP Any one person) <br />$25,000 <br />PERSONAL&ADV INJURY <br />$2,000,000 <br />GEN. <br />AGGREGATE LIMIT APPLIES PER: <br />POLICY [fl jEO 1:1LOC <br />GENERAL AGGREGATE <br />$4,000,000 <br />PRODUCTS-COMP/OP AGO <br />$4,000,000 <br />$ <br />OTHER: <br />A <br />AUTOMOBILE <br />LIABILITY <br />CA4489706 <br />4/1/2025 <br />4/1/2026 <br />COMBINED SINGLE LIMIT <br />$2,000,000 <br />X <br />BODILY INJURY (Per person) <br />$ <br />ANYAUTO <br />OWNED SCHEDULED <br />AUTOS ONLY AUTOS <br />HIRED M NON -OWNED <br />AUTOS ONLYAUTOS ONLY <br />BODILY INJURY (Per accident) <br />$ <br />X <br />PROPERTY DAMAGE <br />Per accident <br />$ <br />UMBRELLA LIAB <br />OCCUR <br />EACH OCCURRENCE <br />$ <br />4EXCESS <br />AGGREGATE <br />$ <br />LIAB <br />CLAIMS -MADE <br />DED RETENTION <br />$ <br />A• <br />WORKERS OMPEN ATIOIN <br />AND Y/N <br />ANYPROPHIETOR/PARTNEWEXECUTIVE N <br />OFFICERIMEMBER EXCLUDED? <br />N/A <br />WC72113158(ADS) <br />WC72113159 (CA) <br />4/1/2025 <br />4/l/2025 <br />4/1/2026 <br />4/1/2026 <br />Xt STATUTE ORTH- <br />E.L. EACH ACCIDENT <br />$ 2,000,000 <br />E.L DISEASE - EA EMPLOYEE <br />$2,000,000 <br />(Mandatory in NH) <br />If es, describe under <br />DESCRIPTION OF OPERATIONS below <br />E.L. DISEASE -POLICY LIMIT <br />$2,000,000 <br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) <br />2SAN041800; CITY OF SANTA ANA ON -CALL WATER RESOURCES ENGINEERING SERVICES <br />PSOMAS, City of Santa Ana AND ITS DIRECTORS, OFFICERS, AGENTS, EMPLOYEES, AND OTHER ENTITIES are named as Additional Insureds with <br />respects to General & Automobile Liability where required by written contract. Waiver of Subrogation in favor of Additional Insured(s) where required by written <br />contract & allowed by law. The above referenced liability policies are primary & non-contributory where required by written contract. Should any of the above <br />described policies be cancelled by the issuing insurer before the expiration date thereof, we will endeavor to provide 30 days' written notice (except 10 days for <br />nonpayment of premium) to the Certificate Holder. <br />CITY OF SANTA ANA <br />Attn.: Jose Medina, P.E. <br />Public Works Agency <br />220 S Daisy Ave; M-85 <br />SANTA ANA CA 92703 <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 />AUTHORIZED REPRESENTATIVE / <br />5 ACORD CORPORATION. All rights reserved, <br />AGUHU ZO (ZUlb/U3) The ACORD name and logo are registered marks of ACORD <br />
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