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Docusign Envelope ID: 1864F19A-F7D4-458B-8446-6741 BF1 E1158
<br /> DATE(MM/DD/YYYY)
<br /> ACC" CERTIFICATE OF LIABILITY INSURANCE
<br /> 07/16/2025
<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 be endorsed. If SUBROGATION IS WAIVED, subject to
<br /> the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the
<br /> certificate holder in lieu of such endorsement(s).
<br /> PRODUCER CONTACT Ben Vandertuin
<br /> NAME:
<br /> Bennett Insurance Agency, LLC PHONE 626-578-5777 FAX
<br /> A/C No Ext: A/C No):
<br /> 1055 E.Colorado Blvd.,5th Floor E-MAIL ben@bennettinsure.com
<br /> ADDRESS:
<br /> INSURER(S)AFFORDING COVERAGE NAIC#
<br /> Pasadena CA 91106 INSURERA: Capitol Specialty Insurance Corp 10328
<br /> INSURED INSURERB: Progressive Insurance 24260
<br /> Omega Environmental Services, Inc INSURERC: State Compensation Insurance Fund 35078
<br /> 1133 Camelback St.,Ste 7261 INSURER D
<br /> INSURER E
<br /> Newport Beach CA 92658 INSURERF:
<br /> COVERAGES CERTIFICATE NUMBER: 23 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 EFF POLICY EXP LIMITS
<br /> LTR IN SD WVD POLICY NUMBER MM/DD/YYYY MM/DDIYYYY
<br /> X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000
<br /> TED
<br /> CLAIMS-MADE � OCCUR PREM SES(DAMAGE ToEa occurrence)
<br /> lcc rrence) $ 100,000
<br /> MED EXP(Any one person) $ 5,000
<br /> A X X EV20240265-02 04/26/2025 04/26/2026 PERSONAL&ADV INJURY $ 2,000,000
<br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000
<br /> X POLICY PRO LOC PRODUCTS-COMP/OPAGG $ 2,000,000
<br /> JECT
<br /> OTHER:El $
<br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 2,000,000
<br /> Ea accident
<br /> X ANY AUTO BODILY INJURY(Per person) $
<br /> B ALL OWNED SCHEDULED X X 01654539 06/08/2024 06/08/2025 BODILY INJURY(Per accident) $
<br /> AUTOS X AUTOS
<br /> NON-OWNED PROPERTYDAMAGE $
<br /> HIRED AUTOS AUTOS Per accident
<br /> UMBRELLALIAB OCCUR EACH OCCURRENCE $
<br /> EXCESS LIAB CLAIMS-MADE AGGREGATE $
<br /> DED RETENTION$ $
<br /> WORKERS COMPENSATION X STATUTE EORH
<br /> AND EMPLOYERS'LIABILITY
<br /> C OF ICERMEMBEREXCLUDED?ECUTIVE Y❑ NIA X 9088276-2025 04/26/2025 04/26/2026 E.L.EACH ACCIDENT $ 1,000,000
<br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000
<br /> If yes,describe under 1,000,000
<br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $
<br /> Professional Liability
<br /> 4 Contractors Pollution Liability EV20240265 02 04/26/2025 04/26/2026 Per Claim $2,000,000
<br /> Per Occurrence $2,000,000
<br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
<br /> City of Santa Ana its City Council, its officers,officials,employees,agents and volunteers all as additional insured.(Per attached endorsements)
<br /> APPROVED
<br /> All operations By Tu Tran Nguyen at 1:32 pm,Jul 21,2025
<br /> Tu Tran n,glta11yslgnedby
<br /> Tu Tran Nguyen
<br /> Date:2121.01.21
<br /> CERTIFICATE HOLDER CANCELLATION
<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: Library Services, Dylan Dario -DocuSioned by,
<br /> 20 Civic Center Plaza, M-45 AUTHORIZED REPRESENTATIVE
<br /> Santa Ana CA 92701
<br /> LtID81H251ED420
<br /> ©1988-2014 ACORD CORPORATION. All rights reserved.
<br /> ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD
<br />
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