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� DATE(MMIDDIYYYY) , <br /> AC4 R" CERTIFICATE OF LIABILITY INSURANCE <br /> 11/a812024 <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 Automatic Data ProcessingInsurance Agency. Inc, <br /> NAME: <br /> Automatic Data Processing Insurance Agency, Inc. (AIIaNIJ Ext: 1-800-524-7024 we No): <br /> E-MAIL <br /> ADDRESS: <br /> 1 Adp Boulevard INSURER(S)AFFORDING COVERAGE NAIC# <br /> Roseland NJ 07068 INSURER A: The Pie Insurance Company 21857 <br /> INSURED Jarrar,Ahmad INSURER B: <br /> INSURER C: <br /> DBA:Maj Engineering INSURER D, <br /> 14608 Fawn Path Road INSURER E: <br /> Chino Hills CA 91709 INSURERF: <br /> COVERAGES CERTIFICATE NUMBER: 3943542 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 S POLICY NUMBER MMIDDIYYYY MMiVD1YYYY <br /> COMMERCIAL GENERAL LIABILITY EACH OCCURRENCEDAMAGE TO RENT1757- <br /> $ <br /> CLAIMS-MADE LOCCUR PREMISES Ea occurrence $ <br /> MED EXP(Any one person) $ <br /> PERSONAL&ADV INJURY $ <br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ <br /> POLICY❑ PRO- ❑LCC PRODUCTS-COMPIOP AGG $ <br /> JECT <br /> OTHER: $ <br /> AUTOMOBILE LIABILITY COMBINED SINGE LIMIT $ <br /> Ea awldent <br /> ANY AUTO BODILY INJURY(Per person) $ <br /> OWNED SCHEDULED BODILY INJURY(Per accident) $ <br /> AUTOS ONLY AUTOS <br /> HIRED NON-OWNED PROPERTY DAMAGE $ <br /> AUTOS ONLY AUTOS ONLY Per accident <br /> UMBRELLA LIAB OCCUR EACH OCCURRENCE $ <br /> EXCESS LIAB HCLAIMS-MADE AGGREGATE $ <br /> ri-DED I I RETENTION$ $ <br /> WORKERS COMPENSATION <br /> AND EMPLOYERS'LIABILITY YINATUTE ER <br /> ANY PROPRIETORIPARTNERIEXECUTIVE E.L.E.L,EACH ACCIDENT $ 1,000,000 <br /> A OFFICERIMEMBEREXCLUDED7 �Y NIA Y WCP11381000-000 06/25/2024 06/25/2025 1,000,OOD <br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ <br /> Ir es,describe under 1,000,DOD <br /> ❑ASCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ <br /> DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) <br /> This certificate of insurance includes a Waiver or Subrogation in favor of the certificate holder. <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:Risk Management Division,4th Floor <br /> AUTHORIZED REPRESENTATIVE <br /> 20 Civic Center Plaza <br /> Santa Ana CA 92701 s �I��� <br /> ©1988-2015 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD --- ----- <br /> (APPROVED <br /> 0.1 r.11 .. r r.....«o.er...... r•....nn:one <br />