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AC" CERTIFICATE OF LIABILITY INSURANCE FDATE(MMIDDIYYYY)
<br /> �� 11/01/2024
<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 Certificate Department
<br /> Assured Partners of California-Santa Ana (949)261-5335 APAO o F ' -1911N Ext: ,No (949)261
<br /> 2913 Pullman Street E-MAIL certificates.nb@assuredpartners.com
<br /> ADDRESS:
<br /> Lic#OM07762 INSURER(S)AFFORDING COVERAGE NAIC#
<br /> Santa Ana CA 92705 INSURERA: Middlesex Insurance Company 23434
<br /> INSURED INSURER B: Starstone National Insurance Company 25496
<br /> PCN3,Inc. INSURER C: CM Vantage Specialty Insurance Company 15872
<br /> 11082 Winner Circle#B INSURER D:
<br /> INSURER E:
<br /> Los Alamitos CA 90720 INSURER F:
<br /> COVERAGES CERTIFICATE NUMBER: 24-25 GL,BA,UMB,WC REVISION NUMBER:
<br /> THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMEDABOVE FOR THE POLICY PERIOD
<br /> INDICATED, NOTWITHSTANDING ANY REQUIREMENT,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 POLICY EFF POLICY EXP
<br /> LTR INSD WVD POLICY NUMBER MMIDDNYYY) (MM/DDfYYYYI LIMITS
<br /> X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
<br /> DAMAGE 8 RENTED
<br /> CLAIMS-MADE XOCCUR PREMISES Ea occurrence $ 500,000
<br /> MED EXP(Anyone person) $ 5,000
<br /> A Y Y A0144715001 01/13/2024 01/13/2025 PERSONAL&ADV INJURY $ 1,000,000
<br /> GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE
<br /> S 3,000,000
<br /> PRO LOC PRODUCTS F 2,000,000
<br /> OTHER: $
<br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT g 1,000,000
<br /> Ea accident
<br /> X ANYAUTO BODILY INJURY(Per person) S
<br /> A OWNED SCHEDULED Y Y A0144715003 01/13/2024 01/13/2025 BODILY INJURY(Per accident) $
<br /> AUTOS ONLY AUTOS
<br /> HIRED NON-OWNED PROPERTY DAMAGE
<br /> AUTOS ONLY AUTOS ONLY (Per...
<br /> $
<br /> X UMBRELLA LIAB X OCCUR EACH OCCURRENCE S 5,000,000
<br /> A EXCESS LIAB CLAIMS-MADE A0144715002 01/13/2024 01/13/2025 AGGREGATE $ 5,000,000
<br /> DED I I RETENTION$ S
<br /> WORKERS COMPENSATION /� SPER TATUTE EORH AND EMPLOYERS'LIABILITY Y/N
<br /> B ANY PROPRIETORIPARTNER/EXECUTIVE NIA Y T10240890 04l01l2024 04/0112025 E.L.EACH ACCIDENT $ 1,000,000
<br /> OFFICERIMEM13ER EXCLUDED? Eyl(Mandatory in NH) EL DISEASE-EA EMPLOYEE $ 1,000,000
<br /> It yes,describe under
<br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000
<br /> Excess Liability
<br /> Each Occurrence $5,000,000
<br /> C Per Occurrence CMVEXL004516101 01/13/2024 01/13/2025 Aggregate $5,000,000
<br /> DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES (ACORD 1.1,Additional Remarks Schedule,may be attached if more space Is required)
<br /> ***Please see attached for additional coverages.`**
<br /> RE:Renovation of Newhope Library(122 N Newhope St,Santa Ana,CA 92703)and Delhi Library(505 E Central Ave,Santa Ana,CA 92707)
<br /> City of Santa Ana,its City Council,officers,officials,employees,agents,and volunteers are named as Additional Insured on the GL per CG2037.0413 and
<br /> CG2010.0413,Waiver of Subrogation per CG2404.0509,Primary Non Contributory per CG2001.0413.Automobile Additional Insured with Primary Non
<br /> Contrubutory per CA7601.0615.Auto Waiver of Subrogation per CA0444.1013.Workers Compensation Waiver of Subrogation per WC040306.0484.
<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 /> Risk Management Division
<br /> 20 Civic Center Plaza AUTHORIZED REPRESENTATIVE
<br /> Santa Ana CA 92701
<br /> ACORD 25(2016103) The ACORD name and logo are registered mAPPROVED
<br /> By Cynthia Mora at 2:01 pm, Nov 05, 202,
<br />
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