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Client#: 150916 EJWAR
<br /> ACORD,,, CERTIFICATE OF LIABILITY INSURANCE F.ATE(M MID DIYYYY)
<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 CONTACT Danelle Touchstone
<br /> USI Insurance Services LLC-CL PHONE 210 524 2094 FAX 610 524-1904
<br /> AIC,No,Exk:_ A7C,No
<br /> SuitNorth Loop 1604 West E-MAIL danelle.touchstone@usi.com
<br /> Suite 410
<br /> INSURERS)AFFORDING COVERAGE NAIC q
<br /> San Antonio,TX 78249 INSURER A:Atlantic Specialty Insurance Company 27154
<br /> INSURED INSURER B:
<br /> E.J.Ward, Inc.
<br /> 12621 Silicon dr.,Ste 113 INSURER C
<br /> San Antonio,TX 78249 INSURER D:
<br /> 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. 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 TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP
<br /> INSR WVO POLICY NUMBER MMIDDIYYYY MMlDDIYYY LIMITS
<br /> A X COMMERCIAL GENERAL LIABILITY 7110163580006 09/01/2024 09101/2025 EACH OCCURRENCE $1,000,000 _
<br /> DAMAGE TO RENTED
<br /> CLAIMS-MADE OCCUR PREMISES Ea occurrence $500 000
<br /> MED EXP(Anyone person) $15,000
<br /> PERSONAL&ADV INJURY S 1,000,000
<br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000
<br /> POLICY�JEC LOC I PRODUCTS-CCMPIOPAGG $2,000,000
<br /> OTHER: $
<br /> A AUTOMOBILE LIABILITY 7110163580006 09101/2024 09/01/202 EOa MIED
<br /> aacid.ntSINGLE LIMIT $1,000,000
<br /> X ANY AUTO BODILY INJURY(Par person) $
<br /> OWNED SCHEDULED BODILY INJURY Par accident $
<br /> AUTOS ONLY AUTOS ( }
<br /> HIRED NON-OWNED PROPERTY DAMAGE
<br /> X AUTOS ONLY X AUTOS ONLY Par accidant $
<br /> A X UMBRELLA LIAB X OCCUR 7110163580006 09/0112024 0910112025 EACH OCCURRENCE $10 000 OOO
<br /> EXCESS LIAR CLAIMS-MADE AGGREGATE S10 000 000
<br /> ❑ED I X RETENTIONS10000 $
<br /> A WORKERS COMPENSATION 4060454430006 09101/2024 09101/202 X PER GTH-
<br /> AND EMPLOYERS'LIABILITY YIN S ATU ER
<br /> ANY PROPRIETORIPARTNERIEXECUTIVE E.L.EACH ACCIDENT $1,O0D O0O
<br /> OFFICERIMEMBER EXCLUDED? NIA - i
<br /> (Mandatary in NH) !E.L.DISEASE-EA EMPLOYEE $1,000,000
<br /> If yes,describe under
<br /> DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT $1,000,000
<br /> A Professional Liab 7600104500006 09/01/2024 0910112025 10,000,000 ea claimlagg
<br /> Cyber Liability 7600104500006 09/01/2024 0910112025 10,000,000 ea claimlagg
<br /> Retention$50,000
<br /> DESCRIPTION OF OPERATIONS I LOCATIONS I 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 /> The General Liability and Auto Liability policy includes a Blanket Additional Insured endorsement that Tu Tran °�Ta'�Ngvy Eby
<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
<br /> #S48436548IM46412308 DDTHZ
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