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AC40R" CERTIFICATE OF LIABILITY INSURANCE FDA'E(MM2025YY)
<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 endorsements .
<br /> PRODUCER CONTACT
<br /> NAME; Jennifer Fleming
<br /> Arthur J.Gallagher Risk Management Services, LLC PHONE FAX
<br /> 500 N Brand Boulevard, Suite 100No.Ex :818.449.0251 we No):
<br /> Glendale CA 91203 ADDRESS: 'ennifer flemin.q@a'g.com
<br /> INSURERS AFFORDING COVERAGE NAIC#
<br /> Liqgnse*OD69293 INSURERA: Berkley Regional Insurance Company 29580
<br /> INSURED INTEMOU-03 INSURER B:Service American Indemnity COm an 39152
<br /> Interval House
<br /> P.O. Box 3356 INSURER C: Underwriters at Lloyd's,London 32727
<br /> Seal Beach, CA 90740 INSURER D:
<br /> INSURER E:
<br /> INSURER F:
<br /> COVERAGES CERTIFICATE NUMBER:2046022536 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 TYPE OF INSURANCE ADDL SUER POLICY NUMBER MM�l7pYlYYYY MMl POLICY
<br /> EXP LIMITS
<br /> A X COMMERCIAL GENERAL LIABILITY Y HHN8525626-18 10/1/2024 10/1/2025 EACH OCCURRENCE $1,000,000
<br /> CLAIMS-MADE L"J OCCUR DAMAGE O ENTED
<br /> PREMISES Ea occurrence $500,000
<br /> MED EXP(Any oneperson) $20,000
<br /> PERSONAL&ADV INJURY $1,000,000
<br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $3,000,000
<br /> POLICY PRO ❑
<br /> JECT LOC PRODUCTS-COMPIOP AGG $3,000,000
<br /> X
<br /> OTHER: $
<br /> A AUTOMOBILE LIABILITY HHN 8526626-18 10/1/2024 10/1/2025 COMBINED SINGLE LIMIT $1,000,000
<br /> Ea accident
<br /> ANYAUTO BODILY INJURY(Per person) $
<br /> OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) $
<br /> X HIRED Ix
<br /> NON-OWNED PROPERTYDAMAGE $
<br /> AUTOS ONLY AUTOS ONLY Per accident
<br /> A UMBRELLA LIAB X OCCUR HHS8525626-18 10/1/2024 10/1/2025 EACH OCCURRENCE $2,000,000
<br /> X EXCESS LIAB CLAIMS-MADE AGGREGATE $z,aoo,oDa
<br /> DED X RETENTION$a $
<br /> B WORKERS COMPENSATION Y SATISO405004 2/1/2025 211/2026 X STATUTE EORH
<br /> AND EMPLOYERS'LIABILITY Y 1 N
<br /> ANYPROPRIETORIPARTNEWFXECUTIVE El NIA
<br /> E.L.EACH ACCIDENT $1,000,000
<br /> OFFICERIMEMBEREXCLUDED?
<br /> (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $1,000,000
<br /> Ityyes describe under
<br /> DESGtRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000
<br /> C CyyberLlability RPS-P-50252618M 10/1/2024 10/1/2025 Limit $1,000,000
<br /> Claimsa4lade form Aggregate $1,000,000
<br /> Retro Date:Full Prior Acts Retention $2,500
<br /> DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) I U I ran y ign
<br /> Policy:Crime Coverage Tu Tran Nguyen
<br /> a
<br /> y 9 Date:2025,n7-28
<br /> Policy Term: 1 011 12 022 To 10/1/2025 Nguyen 07:35:51-07-op'
<br /> Policy#: 107707393
<br /> Carrier:Travelers Casualty and Surety Company of America
<br /> Employee theft: Limit:$2,000,0001 Deductible:$15,000
<br /> ERISA:Limit:$2,000,000 [APPROVEForgery&Alteration:Limit$2,000,0001 Deductible:$15,000 u Tran Nguyen at 7:34 am,Ju128,2025
<br /> Theft Money and Securities:Limit:$2,000,0001 Deductible: $16,000
<br /> See Attached...
<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 /> Attention: Executive Director,
<br /> Community Development Agency
<br /> 20 Civic Center Plaza, M-25, AUTHORIZED REP ESENTATivE
<br /> Santa Ana, CA 92702
<br /> ©1988-2016 ACORD CORPORATION. All rights reserved.
<br /> ACORRD 25(2016103) The ACORD name and logo are registered marks of ACORD
<br />
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