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NATIDAT-01 XOOKDODDAGOUDAR
<br /> ,d►coRo CERTIFICATE OF LIABILITY INSURANCE DATE 12/12/20YYYY)
<br /> 2/12/ 25
<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 Ryan McCarthy
<br /> NAME:
<br /> AssuredPartners of New Jersey,LLC dba AssuredPartners of Northeastern PHONE FAX
<br /> PA (A/C,No,Ext):(570)277-1470 No):(570)277-1470
<br /> 1130 Highway 315 E-MAIL-ADDRESS:Ryan.McCarthy@assuredpartners.com
<br /> Wilkes Barre,PA 18702
<br /> INSURERS AFFORDING COVERAGE NAIC#
<br /> INSURERA:Federal Insurance Company 20281
<br /> INSURED INSURER B:Crum & Forster Insurance Company 42471
<br /> National Data&Surveying Services,Inc INSURERC:Allied World Surplus Lines Insurance Company 24319
<br /> 5967 W.3rd Street
<br /> Ste 206 INSURER D:
<br /> Los Angeles,CA 90036 INSURERE:
<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. 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 TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS
<br /> LTR INSD WVD MM/DD/YYYY MM/DD/YYYY
<br /> A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
<br /> CLAIMS-MADE X OCCUR 36069778 12/1/2025 12/1/2026 rl DAMAGE TO RENTED 1,000,000
<br /> X X PREMISES Ea occurrence $
<br /> MED EXP(Any oneperson) $ 10,000
<br /> PERSONAL&ADV INJURY $ 1,000,000
<br /> GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000
<br /> X POLICY X 71 PEA LOC PRODUCTS-COMP/OP AGG $ 2,000,000
<br /> OTHER: EBLI AGGREGATE $ 1,000,000
<br /> A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000
<br /> Ea accident $
<br /> X ANY AUTO X X 73624017 12/1/2025 12/1/2026 BODILY INJURY Perperson) $
<br /> OWNED SCHEDULED
<br /> AUTOS ONLY AUTOS BODILY INJURY Per accident $
<br /> HIRED NON-OWNED PROPERTY DAMAGE
<br /> AUTOS ONLY AUTOS ONLY Per accident)
<br /> ccident $
<br /> B X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000
<br /> EXCESS LIAB CLAIMS-MADE X X SEO-149919 12/1/2025 12/1/2026 AGGREGATE $ 5,000,000
<br /> DED RETENTION$ $
<br /> WORKERS COMPENSATION PER OTH-
<br /> AND EMPLOYERS'LIABILITY Y/N STATUTE ER
<br /> ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ E.L.EACH ACCIDENT $
<br /> OFFICER/MEMBER EXCLUDED? N/A
<br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $
<br /> If yes,describe under
<br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $
<br /> C Professional Liabili X X 0313-2802 12/1/2025 12/1/2026 Each Occurrence/Aggr 2,000,000
<br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
<br /> When required by written contract:City of Santa Ana,its City Council,its officers,officials,employees,agents,and volunteers are included as additional
<br /> insured with regard to General Liability on a primary and non-contributory basis perform 80-02-2367;Additional insured with regard to Auto Liability perform
<br /> 16-02-0292.Waiver of subrogation applies with regard to General Liability per form 80-02-2000;with regard to Auto Liability per form 16-02-0292.Umbrella
<br /> Liability follow form.30 day notice of cancellation applies.Additional insured and Waiver of subrogation applies with regard to Professional Liability.
<br /> Digitally signed
<br /> Tu Tran by Tu Tran
<br /> Nguyen
<br /> Nguyen 0811:10 0800, APPROVED
<br /> CERTIFICATE HOLDER CANCELLATION BY Tu Tran Nguyen at 8:10 am, Dec 15,2025
<br /> 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 /> Y ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> 20 Civic Center Plaza, M-43
<br /> Santa Ana,CA 92701
<br /> AUTHORIZED REPRESENTATIVE
<br /> ACORD 25(2016/03) V ©1988-2015 ACORD CORPORATION. All rights reserved.
<br /> The ACORD name and logo are registered marks of ACORD
<br />
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