Laserfiche WebLink
ACQR" CERTIFICATE OF LIABILITY INSURANCE DATE(MwDwYYYY) <br /> 6/12/2025 <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: It the certificate holder is an ADDITIONAL INSURED,the policy(les) 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 /> NAMEi Marissa Flomo <br /> GMGS Risk Management & Insurance Services PHONE Ex : 949 559 6700 FgAX No: 949 559 6703 <br /> 6201 Oak Canyon, Suite 100 (A/C Noq L <br /> Irvine, CA 92618 ADDRESS: marissar m s.com <br /> INSURERS AFFORDING COVERAGE NAIC# <br /> www.gmgs.com OB84519 INSURER A: Greenwich Insurance Company 22322 <br /> INSURED INSURER B: Indian Harbor Insurance CompanY 36940 <br /> EEC Environmental INSURER C: Insurance Company of the West 27847 <br /> dba: Environmental Engineering & Contracting, Inc. <br /> One City Boulevard West, Suite 1800 INSURERD: <br /> Orange CA 92868 INSURER E: <br /> INSURER F: <br /> COVERAGES CERTIFICATE NUMBER: 85745245 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 /> 1NSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP <br /> LTR POLICY NUMBER MMIDD YYYY MMfDDNYYY LIMITS <br /> A ✓ COMMERCIAL GENERAL LIABILITY GEC3002766 5/24/2025 5/24/2026 EACH OCCURRENCE $1 004 000 <br /> DAMAGE TO RENTED <br /> CLAIMS-MADE OCCUR PREMISES Ea occurrence $1 Do 000 <br /> IVIED EXP(Any one person) $5 000 <br /> PERSONAL&ADV INJURY $1 000 000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERA!.AGGREGATE $2,000,000 <br /> PR <br /> POLICY W]jFCT LOG PRODUCTS-COMP/OP AGG $2()00,000 <br /> OTHER: $ <br /> A AUTOMOBILE LIABILITY AECO068948 5/24/2025 5/24/2026 ep I'1'1"ED SINGLE LIMIT $f Pao 000 <br /> ANY AUTO BODILY INJURY(Per person) $ <br /> OWNED SCHEDULED BODILY INJURY <br /> AUTOS ONLY ✓ AUTOS (Per accident)1 $ <br /> HIRED NON-OWNED PROPERTY DAMAGE <br /> ✓ AUTOS ONLY ✓ AUTOS ONLY Per accident $ <br /> B UMBRELLA LIAB ,/ OCCUR UEGO068949 5/24/2025 5/24/2026 EACH OCCURRENCE $2 000 000 <br /> ✓ EXCESS LIAB CLAIMS-MADE <br /> AGGREGATE $2 000 400 <br /> DED I I RETENTION $ <br /> C WORKERS COMPENSATION WSD 5066761 03 5/24/2025 5/24/2026 ,/ STATUTE ORH AND EMPLOYERS'LIABILITY Y/N <br /> ANYPAOPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT <br /> OFFICER/MEMBEnEXCLUE NIA <br /> $1 000 000 <br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,0001 <br /> U yes,describe under 00 <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1 000 000 <br /> B Pollution Liability PEC4468954 5/24/2025 5/24/2026 Each Poll Occurrence$5,000,000 <br /> B Professional Liability PECO068954 5/24/2025 5/24/2026 Each Prof Liab Claim$5,000,000 <br /> $10,000,000 Aggregate <br /> DESCRIPTION OF OPERATIONS!LOCATIONS!VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached it more space Is required) <br /> RE:RFP No.25-011 TU Tran TranNguytally enedbyTu <br /> Tran Nguyen <br /> This certificate may be relied upon only if the certificate addendum referred to herein is attached hereto. Nguyen Date:2025,06.19 <br /> 07:44:50-07'00' <br /> APPROVED <br /> CERTIFICATE HOLDER CANCELLATION By TO Tran Nguyen at 7:44ami-Jun 49,2025 <br /> All operations <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 /> Attention: Public Works A ency ACCORDANCE WITH THE POLICY PROVISIONS. <br /> 20 Civic Center Plaza(M-T1) <br /> Santa Ana CA 92701 AUTHORIZED REPRESENTATIVE <br /> Grill Griffith <br /> OO 1988-2015 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD <br /> 85745245 i 25-26 A/G/❑/W/P011/E50 I Marissa Romo 16/12/2025 9:47:17 AM (PDT.) I Page 1 of 22 <br />