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710/20/2025
<br /> E(MM/DD/YYYY)
<br /> ACORO® CERTIFICATE OF LIABILITY INSURANCE
<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 CONTACT
<br /> NAME: Alexander Russell
<br /> Premier Associates Insurance Brokers PHONE FAX
<br /> 949 800-5003
<br /> A/C,No,Ext: (A/C,No):
<br /> 3931 BIRCH ST. ADDRESS: alexgpremieroc.com
<br /> STE.,B INSURER(S)AFFORDING COVERAGE NAIC#
<br /> NEWPORT BEACH CA 92660 INSURER A: BERKLEY ASSUR CO 39462
<br /> INSURED INSURER B: STARSTONE SPECIALTY INS CO 44776
<br /> Triangle Decon Services,Inc. INSURER C: UNITED FINANCIAL CA.CO 11770
<br /> 25422 ADRIANA ST INSURER D: PIE INSURANCE COMPANY 21857
<br /> INSURER E:
<br /> MISSION VIEJO CA 92691-3820 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 /> LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS
<br /> X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
<br /> CLAIMS-MADE OCCUR PREMISES(Ea occurrence) $ 100,000
<br /> MED EXP(Any one person) $ 5,000
<br /> A Y VUMD0365421 09/22/2025 09/22/2026 PERSONAL&ADV INJURY $ 1,000,000
<br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000
<br /> X POLICY ❑ECT ❑LOC PRODUCTS-COMP/OP AGG $ 2,000,000
<br /> OTHER: $
<br /> AUTOMOBILE LIABILITY (Ea accident) $ 1,000,000
<br /> ANY AUTO BODILY INJURY(Per person) $
<br /> OWNED
<br /> C AUTOS ONLY X AUTOSULED 973762079 09/22/2025 09/22/2026 BODILY INJURY(Per accident) $
<br /> HIRED NON-OWNED HF<UHEK I Y DAMAGE $
<br /> X AUTOS ONLY X AUTOS ONLY (Per accident)
<br /> UMBRELLA LAB M
<br /> OCCUR EACH OCCURRENCE $ 2,000,000
<br /> B X EXCESS LAB CLAIMS-MADE Y CSX9078823OP-00 10/15/2025 09/22/2026 AGGREGATE $ 2,000,000
<br /> DED RETENTION$ $
<br /> WORKERS COMPENSATION X STATUTE ER
<br /> AND EMPLOYERS'LIABILITY
<br /> ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT $ 1,000,000
<br /> DOFFICER/MEMBER EXCLUDED? FX1 N/A WC PI 2800953-000 08/19/2025 08/19/2026
<br /> Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000
<br /> If yes,describe under
<br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000
<br /> Per Claim 2,000,000
<br /> A Professional Liability PS00240504128 09/22/2025 09/22/2026 General Aggregate 4,000,000
<br /> Deductible $25,000
<br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
<br /> Additional Insured and Primary &Non Contributory: City of Santa Ana, officers, agents, employees, and
<br /> volunteers are named as additionally insured on this policy pursuant to written contract, agreement, or
<br /> memorandum of understanding. Such insurance as is afforded by this policy shall be primary, and any insurance
<br /> carried by City shall be excess and noncontributory. "30 Days notice Of Cancellation"
<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 /> City of Santa Ana Attention: Public Works Agency...PFRR ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> 220 S Daisy St Digitallysigned AUTHORIZED REPRESENTATIVE
<br /> Tu Tran by Tu Tran
<br /> Nguyen ALe.x.,R-y41L
<br /> Nguyen Date:2025.10.21
<br /> Santa Ana CA 92701 073e48-07'00'
<br /> ©1988-2015 ACORD CORPORATION. All rights reserved.
<br /> ACORD 25(2016/03) APPROVED gistered marks of ACORD
<br /> By Tu Tran Nguyen at 7:36 am,Oct 21,2025
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