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DATE
<br /> ACORO® CERTIFICATE OF LIABILITY INSURANCE (MM/DD/YYYY)
<br /> 1 06/05/2025
<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 NAME CT Erica Vazquez
<br /> Pacific Lighthouse Insurance Agency, Inc. PHONE FAx
<br /> 217 N. Main Street Suite 101 AIC No EXt: (657)667-0225 A/c No: (657)667-0227
<br /> Santa Ana, CA 92701 ADDRESS: Erica@PacificLighthouseins.com
<br /> License#: OG22040 INSURER(S)AFFORDING COVERAGE NAIC#
<br /> INSURERA: Sentinel Insurance Company 11000
<br /> INSURED Talley&Talley Law,APC INSURERB: Sequoia Inurance Company 22985
<br /> 27201 Puerta Real INSURERC: National Liability&Fire Insurance Company 20052
<br /> Suite 300 INSURER D:
<br /> Mission Viejo, CA 92691 INSURER E7
<br /> INSURER F:
<br /> COVERAGES CERTIFICATE NUMBER: 00000960-0 REVISION NUMBER: 43
<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 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
<br /> POLICY EFF POLICY EXP
<br /> LT R POLICY NUMBER MM DD YYYY MM/DD YYYY LIMITS
<br /> A X COMMERCIAL GENERAL LIABILITY Y Y 57 S BM BP3810 06/09/2024 06/09/2026 EACH OCCURRENCE $ 2,000,000
<br /> CLAIMS-MADEFvl DAMAGE TO RENTED
<br /> X OCCUR PREMISES Ea occurrence $ 1,000,000
<br /> MED EXP(Any one person) $ 10,000
<br /> PERSONAL&ADV INJURY $ 2,000,000
<br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 4,000,000
<br /> X POLICY D PRO-
<br /> JECT LOC PRODUCTS-COMP/OP AGG $ 4,000,000
<br /> OTHER: $
<br /> MBIED
<br /> A AUTOMOBILE LIABILITY Y 57 SBM BP3810 06/09/2024 06/09/2025 (CEO,acccldentSINGLE LIMIT $ 2,000,000
<br /> ANY AUTO BODILY INJURY(Per person) $
<br /> OWNED SCHEDULED BODILY INJURY(Per accident) $
<br /> AUTOS ONLY AUTOS
<br /> HIRED NON-OWNED PROPERTY DAMAGE X AUTOS ONLY X AUTOS ONLY Per accident $
<br /> UMBRELLA LIAB OCCUR EACH OCCURRENCE $
<br /> EXCESS LIAB CLAIMS-MADE AGGREGATE $
<br /> DED F7 RETENTION$ $
<br /> B WORKERS COMPENSATION PER
<br /> IN Y QWC1390251 09/07/2024 09/07/2026 X STATUTE OERH
<br /> AND EMPLOYERS'LIABILITY
<br /> ANY PROPRIETOR/PARTNER/EXECUTIVE Y❑ E.L.EACH ACCIDENT $ 1,000,000
<br /> OFFICER/MEMBER EXCLUDED? Y NIA
<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 /> C Errors and Omissions LP009892 10/09/2024 10/09/2026 Per Claim/Aggregat $2M/$2M
<br /> DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
<br /> City of Santa Ana, its City Council, officers, officials, employees,agents, and volunteers as additional insureds are covered as
<br /> additional insureds, under the Attorneys'General Liability policy with respect to any liability arising out of the work or
<br /> operations performed by or on behalf of the instructor including materials, parts, equipment,and personnel furnished in
<br /> connection with such work or operations.
<br /> Attorneys insurance companies agree to waiver all rights of subrogation against City, its City Council. its officers, officials,
<br /> continued on ACORD 101 Additional Remarks Schedule
<br /> CERTIFICATE HOLDER APPROVED CANCELLATION
<br /> By Tu Tran Nguyen at 2:02 pm,Jun 09,2025 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> City of Santa Ana THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN
<br /> Attn: City Manager's Office ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> 20 Civic Center Plaza, M-29
<br /> Santa Ana, CA 92701 AUTHORIZED REPRESENTATIVE
<br /> EVZ
<br /> ©1988-2015 ACORD CORPORATION. All rights reserved.
<br /> ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD Printed by EVZ on 06/05/2025 at 05:38PM
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