|
TE
<br /> A`"R"� CERTIFICATE OF LIABILITY INSURANCE oA4/30/2025YY)
<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 1
<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
<br /> IAG Insurance Services NAME: Suzanne S.f Osada
<br /> 111 Corporate Drive, Suite 100 I°N x , 949-396-1015 FAX
<br /> PH C No;949-387-2324
<br /> Ladera Ranch CA 92694 ADM AL sbp@iagins.com
<br /> INSURER(S)AFFORDING COVERAGE NAIC#
<br /> License#: 0D76344 INSURER A:American Casualty Company of Readin , 20427
<br /> INSURED CLINLAB-01 INSURERB:Continental Casualty Companv 20443
<br /> Clinical Laboratory of San Bernardino
<br /> Geo-Monitor, Inc. INSURER C:Oak River Insurance Co. 34630
<br /> 21881 Barton Road INSURER D:Transportation Insurance Company 20494
<br /> Grand Terrace CA 92313 INSURER E:
<br /> INSURER F:
<br /> COVERAGES CERTIFICATE NUMBER:887937365 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 ADDLSUBR POLICY EFF POLICY EXP
<br /> FYPE OFINSURANC[o
<br /> LTR POLICYNUMBER MWODffYYY MM/DDlYYYY LIMITS
<br /> A X COMMERCIAL GENERAL LIABILITY Y Y 6072997663 2/1/2025 2/1/2026 EACH OCCURRENCE $1,000,000
<br /> CLAIMS-MADE O OCCUR DAMAGE (RENTED
<br /> PREMISESS Ea occurrence) $100,000
<br /> MED EXP(Any one person) $10,000
<br /> PERSONAL&ADV INJURY $1,000,000
<br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000
<br /> X POLICY P PRO-
<br /> JECT LOG PRODUCTS-COMPfOP AGG S 2,000,000
<br /> OTHER: $
<br /> D AUTOMOBILE LIABILITY Y Y 7036574348 211/2025 2/1/2026 COMBINED SINGLE LIMIT $1,000,000
<br /> Es accident
<br /> X ANY AUTO BODILY INJURY(Per person) $
<br /> OWNED SCHEDULED
<br /> AUTOS ONLY AUTOS BODILY INJURY(Per accident) $
<br /> X HIRED X NON-OWNED PROPERTYDAMAGEt
<br /> AUTOS ONLY AUTOS ONLY Per acrid
<br /> en $
<br /> $
<br /> H X UMBREELLALIAO X OCCUR CUE6076281162 21112025 2/112026 EACH OCCURRENCE $5.000,000
<br /> EXCESS LIAB CLAIMS-MADE AGGREGATE $5,000,000
<br /> DED I 'X RETENTION$in nnn $
<br /> C WORKERS COMPENSATION Y CLWC666456 2/1/2025 2/1/2026 X SPER TATUTE ERH
<br /> AND EMPLOYERS'LIABILITY Y I N
<br /> ANYPROPRIETORfPARTNERIEXECUTIVE E.L.EACH ACCIDENT $1,000,000
<br /> OFFICE RIMEMBER EXCLUDED? a N f A
<br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE S 1,000,001)
<br /> If yes,describe under
<br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000
<br /> B Environmental Prat Liability Y EEH276170923 21112025 2/1/2026 Per Claim $4.000.000
<br /> Claims Made Aggregate $4,000.000
<br /> Deductible $100,000
<br /> DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
<br /> RE:All Operations usual to the insured's operations are subject to the policy terms and conditions.
<br /> City of Santa Ana,its officers,officials,employees, and volunteers are included as Additional Insureds to the General Liability.Coverage is Primary&
<br /> Non-Contributory,and a Waiver of Subrogation applies.
<br /> Blanket Auto Liability Additional Insured is included as required by written contract.Waiver of Subrogation applies with respect to Auto Liability.
<br /> Blanket Waiver of Subrogation for Workers'Compensation shall apply as required by written contract per the attached endorsement.
<br /> See Attached...
<br /> CERTIFICATE HOLDER APPROVED CANCELLATION
<br /> By Tu Tran Nguyen at 7.16 am,May 01,2025
<br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br /> City of Santa Ana ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> Attn: Public Works Agency
<br /> Robert Hernandez
<br /> 20 Civic Center Plaza AUTHORIZED REPRESENTATIVE
<br /> Santa Ana CA 92701
<br /> O 1988-2015 ACORD CORPORATION. All rights reserved.
<br /> ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD
<br />
|