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Client#: 150916
<br />EJWAR
<br />ACORD,,, CERTIFICATE OF LIABILITY INSURANCE
<br />DATE(MMfDD1YYYY)
<br />03/06/2025
<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 pollcy(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
<br />CONTACT Danelle Touchstone
<br />USI Insurance Services LLC -CL
<br />PHONE 210 524 2094 FAX 610 524-1904
<br />AIC, No, Exk : _ A7C, No
<br />SuitNorth Loop 1604 West
<br />E-MAIL danelle.touchstone@usi.com
<br />Suite 410
<br />San Antonio, TX 78249
<br />INSURERS) AFFORDING COVERAGE
<br />NAIC q
<br />INSURER A: Atlantic Specialty Insurance Company
<br />27154
<br />INSURED
<br />E.J. Ward, Inc.
<br />INSURER B :
<br />12621 Silicon dr., Ste 113
<br />INSURER C
<br />San Antonio, TX 78249
<br />INSURER D :
<br />INSURER E :
<br />INSURER F
<br />CUVERAGE5 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 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 />IN RR
<br />TYPE OF INSURANCE
<br />ADDL
<br />INSR
<br />SUBR
<br />WVD
<br />POLICY NUMBER
<br />POLICY EFF
<br />MMfDD1YYYY
<br />POLICY EXP
<br />00IDDIYYY LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE OCCUR
<br />7110163580006
<br />09/01/2024
<br />09101/2025
<br />EACH OCCURRENCE
<br />$1,000,000
<br />DAMAGE TO RENTE❑
<br />PREMISES Ea occurrence
<br />_
<br />$5OO OOO
<br />MED EXP (Anyone person)
<br />$15,000
<br />PERSONAL & ADV INJURY
<br />S 1,000,000
<br />AGGREGATE LIMIT APPLIES PER:
<br />POLICY � JEC LOC
<br />GENERAL AGGREGATE
<br />$2,000,000
<br />GEN'L
<br />I PRODUCTS - CCMPIOPAGG
<br />$2,000,000
<br />$
<br />OTHER:
<br />A
<br />AUTOMOBILE
<br />LIABILITY
<br />7110163580006
<br />09101/2024
<br />09/01/202
<br />EOa MIED
<br />aacid.ntSINGLE LIMIT
<br />$1,000,000
<br />X
<br />ANY AUTO
<br />BODILY INJURY (Par person)
<br />$
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />BODILY INJURY Par accident
<br />( }
<br />$
<br />X
<br />HIRED NON -OWNED
<br />AUTOS ONLY X AUTOS ONLY
<br />PROPERTY DAMAGE
<br />Par accidant
<br />$
<br />A
<br />X
<br />UMBRELLA LIAB
<br />X
<br />OCCUR
<br />7110163580006
<br />09/0112024
<br />0910112025
<br />EACH OCCURRENCE
<br />$10 000OOO
<br />AGGREGATE
<br />S10 000 000
<br />EXCESS LIAR
<br />CLAIMS -MADE
<br />❑ED I X RETENTIONS10000
<br />$
<br />A
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY YIN
<br />ANY PROPRIETORIPARTNERIEXECUTIVE
<br />OFFICERIMEMBER EXCLUDED?
<br />NIA
<br />4060454430006
<br />09101/2024
<br />09101/202
<br />X PER OTH-
<br />S ATU ER
<br />E.L. EACH ACCIDENT
<br />-
<br />$1,OOD OOO
<br />i
<br />E.L. DISEASE - EA EMPLOYEE
<br />$1,000,000
<br />(Mandatory in NH)
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />!
<br />EL DISEASE - POLICY LIMIT
<br />$1,000,000
<br />A
<br />Professional Liab
<br />7600104500006
<br />09/01/2024
<br />0910112025
<br />10,000,000 ea claimlagg
<br />Cyber Liability
<br />7600104500006
<br />09/01/2024
<br />0910112025
<br />10,000,000 ea claimlagg
<br />Retention $50,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS f VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
<br />Project Name and Location: Upgrade Fueling Stations Proj #25-6038 - City Corporate Yard
<br />nbY
<br />The General Liability and Auto Liability policy includes a Blanket Additional Insured endorsement that Tu Tran DuTaln
<br />Nguy
<br />provides Additional Insured and a Waiver of Subrogation status to, City of Santa Ana, its City Council, Date 2025.0701
<br />officers, officials, employees, agents and volunteers, only when there is a written contract or written Nguyen ,0264-07'00'
<br />agreement between the named insured and the certificate holder that requires such status. The General
<br />(See Attached Descriptions)
<br />CERTIFICATE HOLDER CANCELLATION APPROVED
<br />SyTu Tran Nguyen at 10:23 am, Jul Oi, 2025
<br />City of Santa Ana SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />Attn: Public Works Agency - ACCORDANCE WITH THE POLICY PROVISIONS.
<br />Water Resources
<br />215 S. Center St. M-85 AUTHORIZED REPRESENTATIVE
<br />Santa Ana, CA 92703
<br />I
<br />O 1988.2015 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2016103) 1 of 2 The ACORD name and logo are registered marks of ACORD
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