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AGUI&CA-01 DCOSTA
<br /> '4<7"R" CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY)
<br /> 411412025
<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
<br /> NAME:
<br /> Shank Insurance Services PHONE FAX
<br /> 122 Avenida del Mar (A/C,No,EXt):(833)878-2820 (A/C,No):(702)870-1263
<br /> Ste C E-MAIL insurance insurance@swartsmanning.com
<br /> � 9•com
<br /> San Clemente,CA 92672-4068
<br /> INSURERS AFFORDING COVERAGE NAIC#
<br /> INSURER A:Gemini Ins Co 10833 _
<br /> INSURED INSURER B:AmGUARD Ins Co 42390
<br /> Aguilar&Calderon Corporation INSURER C:Praetorian Ins Co 37257
<br /> 15738 Yermo St INSURER D:Ohio Security Ins Co 24082
<br /> Whittier,CA 90603 INSURER E:Evanston Ins Co 35378
<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 POLIICDY EFF POLICY EXP LIMITS
<br /> A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
<br /> CLAIMS-MADE X OCCUR VCGPO31907 5/25/2024 5/25/2025 DAMAGE TO RENTED 100,000
<br /> X X PREMISES Fa c u ence $
<br /> MED EXP(Any oneperson) 5,000
<br /> PERSONAL&ADV INJURY 1,000,000
<br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE 2,000,UUU
<br /> X POLICY PE� LOC PRODUCTS-COMP/OP AGG $ 2,000,000
<br /> OTHER:
<br /> B AUTOMOBILE LIABILITY COBINED SINGLE LIMIT 1,000,000
<br /> Ea M accident $
<br /> X ANY AUTO X X AGAU502242 5125/2024 5/25/2025 BODILY INJURY Per person) $
<br /> OWNED SCHEDULED
<br /> AUTOS ONLY AUTOS BODILY INJURY Per accident $
<br /> AUTOS ONLY AUUTOS ONLYY PerOacade t AMAGE $
<br /> A X UMBRELLA LIAB X OCCUR EACH OCCURRENCE Is 2,000,000
<br /> EXCESS LIAB CLAIMS-MADE VCFX003297 5/25/2024 5/25/2025 AGGREGATE
<br /> DED RETENTION$ AGG 2,000,000
<br /> C WORKERS COMPENSATION X PER OTH-
<br /> AND EMPLOYERS'LIABILITY STATUTE ER 1
<br /> ANY PROPRIETORJPARTNERIEXECUTIVE Y/N X FWCO400073 5l2512024 5I25l2025 E.L.EACH ACCIDENT I$ 1��������
<br /> OMandatory in NHR EXCLUDED? a NIA 1'000'000
<br /> E.L.DISEASE-EA EMPLOYE $
<br /> If yes,describe under 1,000,000
<br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $
<br /> D Installation Floater BM067998728 7/20/2024 5/25/2025 Per Jobsite 250,000
<br /> E Contractor Pollution CPLMOL121763 2/212024 5/21/2025 General Aggregate 2,000,000
<br /> DESCRIPTION OF OPERATIONS f LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space is required)
<br /> RE:Project#25-6029-Sidewalk Replacement Project FY 24125
<br /> City of Santa Ana,its officers,employees,agents and representatives are named as additional insured with respect to the General Liability where required by
<br /> written contract as per form#CG2010 07-04 on a Primary and Non-Contributory basis as per form#VE0973 04-20 and Commercial Auto per form#BA9904
<br /> 06/18.Waiver of Subrogation applies to the General Liability as per attached form#CG240412-19,Commercial Auto per form#BA9902 09108 and Workers
<br /> Compensation as per form#WC040306 04-84.
<br /> Digitally signed
<br /> Tu Tl d n by Tu Ng"'nan APPROVED
<br /> Nguyen
<br /> Nguyen Date:2025.04.15
<br /> 10:35:13-07'00' By Tu Tran Nguyen of 10:34 am,Apr 15,2025
<br /> CERTIFICATE HOLDER CANCELLATION
<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 /> ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> Attention:Public Works Agency,M-22
<br /> 20 Civic Center Plaza
<br /> Santa Ana,CA 92701 AUTHORIZED REPRESENTATIVE
<br /> ACORD 25(2016103) ©1988-2015 ACORD CORPORATION. All rights reserved.
<br /> The ACORD name and logo are registered marks of ACORD
<br />
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