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Act O® CERTIFICATE OF LIABILITY INSURANCE DATE(MMroorYYYY)
<br /> 05/07/2026
<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 Daryl Zam
<br /> 11 Bravo Insurance Services NAME: ry
<br /> 23705 Vanawen St.#307 P"CNo Ext: (818)351-5777 � No; (818)351-5778
<br /> West Hills, CA 91307 E-MAIL
<br /> ADDRESS: Daryl@11bravoins,com
<br /> License#: OM79887 INSURERS AFFORDING COVERAGE NAIC If
<br /> INSURER A: Gotham Insurance Company
<br /> INSURED N S S CONSTRUCTION INSURER B: Pro ressive West Ins Co
<br /> DBA: B
<br /> RON S INSURER C: Nautilius Insurance Co
<br /> 18440 HATTERAS ST 33 INSURER : Evanston Insurance Company
<br /> Tarzana, CA 91356 INSURERE:
<br /> INSURER F
<br /> COVERAGES CERTIFICATE NUMBER: 00001342-250402183753 REVISION NUMBER: 7
<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 REQUIREMLNT,TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
<br /> CERTIFICATE MAYBE 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
<br /> LTR POLICY NUMBER MMlDD1YYYY MMOWYYYY LIMITS
<br /> A x COMMERCIAL GENERAL LIABILITY Y Y GL202500028129 01107/2026 01107/2026 EACH OCCURRENCE $ 1,000 000
<br /> DAMAGE TO RETED
<br /> CLAIMS-MADE �OCCUR PREMISES(Ea oecu r nce) $ 300,000
<br /> MED EXP(Anyone person) $ 5,0()()
<br /> PERSONAL&AOV INJURY S 1,000,000
<br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE 2,000,000
<br /> POLICY ECT ❑LOG PRODUCTS-COMPIOP AGG $ 2,000,000
<br /> OTHER: $
<br /> B AUTOMOBILE LIABILITY Y Y 993140787 02/1412026 02/1412026 EOa eoodeDISINGLE LIMIT $ 1 000 000
<br /> X ANY AUTO BODILY INJURY(Per person) S
<br /> OWNED SCHEDULED
<br /> AUTOS ONLY AUTOS BODILY INJURY(Per accldenl) $
<br /> X X
<br /> HIRED NON-OWNED PROPERTY DAMAGE
<br /> X AUTOS ONLY X AUTOS ONLY Per accident $
<br /> UMBRELLA u B OCCUR AN1346546 04/28/2025 01107/2026 EACH OCCURRENCE $ 5,000,000
<br /> EXCESS LIAB CLAIMS-MADE AGGREGATE S 10,000,000
<br /> DED RETENTION$ S
<br /> WORKERS COMPENSATION IPER OTH-
<br /> AND EMPLOYERS'LIABILITY Y 1 N STATUTE I I ER
<br /> ANY PROPRIETORIPARTNERIEXECUTNE
<br /> OFFICERYMEMBER EXCLUDED? NIA E.L.EACH ACCIDENT $
<br /> (Mandatory In NHI E.L.DISEASE-EA EMPLOYE $
<br /> If yes,describe under
<br /> _ I DESCRIPTION OF OPERATIONS helow E.L.DISEASE-POLICY LIMIT $
<br /> D Pollution Liability CPLMOL131126 04/28/2025 04/2812026 Per claim/Aggregate $1 M!$2M
<br /> DESCRIPTION OF OPERATIONS I LOCATION$I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
<br /> Commercial umbrella for$5,000,000 per occurrence and$10,000,000 aggregate is over the commercial general liability(CGL)
<br /> and the commercial auto liability (AL). Making the CGL$6,000,000 per occurrence and $11,000,000 aggregate and making the
<br /> AL:$6,000,000 combined single limit. City of Santa Ana, its City Council, officers,officials,employees, agents,and volunteers
<br /> are to be covered as additional insureds on Contractor's CGL and AL policies with respect to liability arising out of work
<br /> operations performed by or on behalf of Contractor including materials, parts,and equipment furnished in connection with
<br /> such work or operations and automobiles owned, leased, hired, or borrowed by or on behalf of Contractor.Additional insured
<br /> continued on ACORD 101 Additional Remarks Schedule
<br /> CERTIFICATE HOLDER APPROVED ICANCELLATION
<br /> By Tu Tran Nguyen at 8.22 am,May 12,2025 I 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 /> 20 Civic Center Plaza T D'egitally signed
<br /> Santa Ana, CA 92701 Tu 1 ran by Tu Tran Nguyen AUTHORIZED REPRESENTATIVE
<br /> Nguyen Date:2025.05 12
<br /> 7 08:26:40-07'00'
<br /> DSZ
<br /> Q 1988-2015 ACORD CORPORATION. All rights reserved.
<br /> ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD Printed by DSZ on 05/07/2025 at 03:05PM
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