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Client#: 74070 BIDANYU
<br /> ACORD,., CERTIFICATE OF LIABILITY INSURANCE DATE(MMIODfYYYY)
<br /> 310712025
<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 any rights to the certificate holder in lieu of such endorsement(s).
<br /> PRODUCER NAAME: T Rosanne Coyne
<br /> AssuredPartners of Ohio, LLC PHONE 440 333-9000 FAx
<br /> AfC,No,Ext: (AIC,No): _
<br /> 3900 Kinross Lakes Pkwy#300 E-MAIL ADDRESS: SBUProofs@AssuredPartnersOH.com
<br /> Richfield, 44286-9445 INSURERS)AFFORDING COVERAGE NAIC#
<br /> 440 333-9000 00 United States Liability INSURER A: y Insurance Ca 25895
<br /> INSURED INSURER B:Hartford Fire Insurance Co 19682
<br /> BI Dan Yu dba Young Rembrandts North
<br /> INSURERC:
<br /> Orange County
<br /> 1060 N. Mar Vista Ave. IN D
<br /> INSURER
<br /> Pasadena, CA 91104 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, NOTWITHSTANDENG ANY REQUIREMENT, TERM OR CONDETION OF ANY CONTRACTOR 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 TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP
<br /> LTR INSR WVD POLICY NUMBER MMfDD1YYYY MMIUDIYYYY LIMITS
<br /> A X COMMERCIAL GENERAL LIABILITY X X GL1190670B 03/0712025 03107/2026 EACH OCCURRENCE 51,000,000
<br /> CLAIMS-MADE I A�OCCUR PREM SE3(Ea occ rrence S100,000
<br /> MED EXP(Any one person) $5,000
<br /> PERSONAL&ADV INJURY $1,000,000
<br /> GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE 52,000,000
<br /> X POLICY F7 PRO-
<br /> F LOC PRODUCTS-COMPlOPAGG 52,000,000
<br /> OTHER: S
<br /> A AUTOMOBILE LIABILITY X GL1190670B 03/0712025 03/07/202 E°a aBNED SINGLE LIMIT S1,000,000
<br /> ANY AUTO BODILY INJURY(Per person) 5
<br /> OWNED SCHEDULED BODILY INJURY(Per accident) 5
<br /> AUTOS ONLY AUTOS
<br /> HIRED NON-OWNED PROPERTY DAMAGE
<br /> X AUTOS ONLY X AUTOS ONLY Per accident) _ s
<br /> 5
<br /> A X UMBRELLA LIAB X OCCUR CUP1572191B 03107/2025 03107/2026 EACH OCCURRENCE s2 000,000
<br /> EXCESS LIAB CLAIMS-MADE. AGGREGATE s2,000,000
<br /> DE❑ RETENTION,$ $
<br /> B WORKERS COMPENSATION X 45WECAW2FB9 03/07/2025 03/071202 PER X OTH-
<br /> AND EMPLOYERS'LIABILITY YIN T
<br /> R
<br /> ANY PROPRIETORIPARTNERIEXECUTIVE E.L.EACH ACCIDENT $1,000 000
<br /> OFFICERIMEMBER EXCLUDED? F N I A
<br /> (Mandatory in NH) E.L.DISEASE-FA EMPLOYEEI 51,000,000
<br /> if yes,describe under
<br /> DESCRIPTION OFOPERATQNSbelcw I EL_DISEASE-POLICY LIMIT I s1,000,000
<br /> A Sexual Abuse/ X GL1190670B 03/07/2025 03107/202 $1,000,00032,000,000
<br /> Molestation
<br /> A Professional Llab GL1190670B 03/07/2025 03I071202 $1,000,000/$2,000,000
<br /> DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES iACORD 101,Additional Remarks Schedule,maybe attached if more space is required)
<br /> The City of Santa Ana,its officers,officials,employees, and volunteers are to be covered as Digitauysigned
<br /> additional insureds on the CGL policy with respect to liability arising out of work or operations TU Tran by Tu Tran
<br /> Nguyen
<br /> performed by or on behalf of the Permittee including materials, parts, or equipment furnished in Nguyen Date:2025.03.24
<br /> connection with such work or operations.A Waiver of Subrogation is in favor of the City of Santa 1 li:3ssi-oroo
<br /> Ana for the General Liability,Auto and Sexual Abuse and Molestation and Worker's Compensation
<br /> policies.
<br /> APPROVED
<br /> CERTIFICATE HOLDER CANCELLATION By Tu Tran Nguyen at 11:38 am,Mar 24,2025
<br /> City Of Santa Ana Parks and SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br /> Recreation Dept. ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> 185 W. Civic Center Dr.
<br /> Santa Ana,CA 92703 AUTHORIZED REPRESENTATIVE
<br /> g 1988-2015 ACORD CORPORATION.All rights reserved.
<br /> ACORD 25(2016103) 1 of 1 The ACORD name and logo are registered marks of ACORD
<br /> #S 10905161M 1090496 EG O LT
<br />
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