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MIKEBUB-01 ASHUNN
<br /> ACORO DATE(MMIDDrYYYY)
<br /> CERTIFICATE OF LIABILITY INSURANCE 2/5/2025
<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 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 endorsemenk(s).
<br /> PRODUCER License#OM63276 CANTAcr
<br /> Gallant Risk and Insurance Services, LLC PHONE FAX
<br /> 4160 Temescal Canyon Rd.Suite 214 Arc,No,Ext):(951) 368-0700 Arc,Ne):(951)368-4707
<br /> Corona,CA 92883 EMAIL
<br /> ADDRESS:
<br /> I MSURER(Sl AFFORDING COVERAGE NAIC#
<br /> INSURER A:Hartford Fire Insurance Company 19682
<br /> INSURED INSURER B:Trumbull Insurance Company 27120
<br /> Mike Bubalo Construction Co., Inc. INSURER c:Hartford Casualty Insurance Company 29424
<br /> 5102 Gayhurst Ave. INSURER D:Sentinel Insurance Company, Ltd 11000
<br /> Baldwin Park,CA 9170636940
<br /> INSURER E:Indian Harbor Insurance Com an
<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 /> ILTR NSR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP
<br /> LIMITS
<br /> A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 1,000,000
<br /> CLAIMS-MADE [X] OCCUR X X 72UEABK2UAB 111/2025 11112026 DAMAGE
<br /> PREMISETO RENT rrDence � 300,000
<br /> MED EXP(Any one person 5,000
<br /> PERSONAL&ACV INJURY S 1,000,000
<br /> GEN'L AGGREGATE LIMIT APPLIES PER, GENERAL AGGREGATE g 2,000,000
<br /> POLICY❑X PRO-
<br /> JECT 1:1 LOC PRODUCTS-COMPIOP AGG S 2,000,000
<br /> OTHER:
<br /> B AUTOMOBILE LIABILITY EOMaBINEeDISINGLE LIMIT $ 1,000,000
<br /> X ANY AUTO X X 72UEACM5971 1/1/2025 111/2026 BCDILY INJURY Per person) S
<br /> OWNED SCHEDULED
<br /> AUTOS ONLY AUTOS BODILY INJURY Per accident S
<br /> X HIRED X NON-OWNED
<br /> AUTOS ONLY P.RIaIwintDAMAGE $
<br /> AUTOS ONLY
<br /> C X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 8,000,000
<br /> EXCESS LIAB CLAIMS-MADE X X 72HHASK2UF7 1/1/2025 1/1/2026 AGGREGATE g 8,000,000
<br /> DE❑ X RETENTION$ 1000
<br /> D WORKERS COMPENSATION PER OTH-
<br /> AND EMPLOYERS'LIABILITY X STATUTE ER
<br /> ANY PROPRIETORIPARTNERIEXI IVE YIN X 72WEABB8AXT 1/1/2025 111/2026 E.L.1=aGH ACCIDENT g OU0,00 1,
<br /> OFFICERIMEMBER EXCLUDED? ® NIA
<br /> (Mandatory in NH 1,000,000
<br /> }If yes,describe under E.L.DISEASE-EA EMPLOYE $
<br /> DESCRIPTION OF OPERATIONS below F L DISEASE-POLICY LIMIT S 1,000,000
<br /> E Professional E&O PECO01304022 111/2025 11112026 Each Claim/Aggre 5,000,000
<br /> E Pollution Liab PECO01304022 11112025 1/1/2026 Each ClaimlAggre 5,000,000
<br /> DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached if more space is requIred)
<br /> PROJECT NO.:23-6627
<br /> ROUSSELLE STREET FLOOD PROTECTION PROJECT
<br /> City of Santa Ana,its City Council,officers,officials,employees,agents,and volunteers are included as Additional Insured with regards to General Liability
<br /> and Auto Liability,with coverage on a primary and non-contributory basis.Waivers of Subrogation apply in favor of additional insured with regards to General
<br /> Liability and Auto Liability and Workers Compensation.
<br /> APPROVED
<br /> By Tu Tran Nguyen of 11.31 am,Feb 05,2025
<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 /> 20 Civic Center Plaza M-22 ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> Santa Ana,CA 92701 Digitally sign d by
<br /> Attn: Public Works Agency AUTHORIZED REPRESENTATIVE Nguyen Date:2025.0 05
<br /> 11:32:04-06' 0'
<br /> ACORD 25(2016103) O 1988-2015 ACORD CORPORATION. All rights reserved.
<br /> The ACORD name and logo are registered marks of ACORD
<br />
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