|
0 CERTIFICATE OF LIABILITY INSURANCE DATE(MMroDfWWj
<br /> 5/12/2025
<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: If the certificate holder Is an ADDITIONAL INSURED,the policy(les)must have ADDITIONAL INSURED provisions or be endorsed.
<br /> If SUBROGATION 1S 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 Ileu of such endorsements.
<br /> PRODUCER N�M :CONTACT Lauren Ma er
<br /> McGriff Insurance Services LLC PHONE Wxc
<br /> No
<br /> 2200 N. Commerce Parkway Arc o Ext:954-385-6022 arc ;866-802-8684
<br /> Suite 200 ADDRIESS: lauren,ma er m riff.com
<br /> Weston FL 33326 INSURERS AFFORDING COVERAGE NAIC#
<br /> INSURERA: Berkshire Hathaway Homestate Ins Co 20044
<br /> INSURED 132SAFEBLLC INSURERB; Everest Indemnity Insurance Company 10351
<br /> Interwest Consulting Group, Inc. INSURERC: Everest Premier Insurance Company 16045
<br /> 444 N Cleveland Ave;
<br /> Loveland CO 80538 INSURERD; Bridgeway Insurance Company 12489
<br /> INSURER E: Great American E&S Insurance Company 37532
<br /> INSURERF: Great American E&S Insurance Company 375532
<br /> COVERAGES CERTIFICATE NUMBER.,507503014 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 /> LTR TYPEOFINSURANCE ANSD BWVD POLICY NUMBER MMIDDYEFF MWDD YY. LIMITS
<br /> 6 X COMMERCIALGENERALLIABILITY Y Y CF3GL00416241 IOIW2024 10/3/2026 EACH OCCURRENCE $11000,000
<br /> DAMAGE TO RENTEU—
<br /> CLAIMS-MADE PCI OCCUR PREMISES Ea occurrence) $300,000
<br /> X 10,000 MED EXP{Any one person) $10,000
<br /> PERSONAL&ADV INJURY $1,000,000
<br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000
<br /> X POLICY JECOT- LOC PRODUCTS-COMPIOPAGO $2,ODD,00D
<br /> OTHER: $
<br /> C AUTOMOBILE LIABILITY Y Y CF3CA00337241 1002024 10/3/2025 coEaMBI accidentdent)NEDS GLE LIMIT $110001000
<br /> X ANYAUTO BODILY INJURY(Per person) $
<br /> OWNED SCHEDULED BODILY INJURY(Per accident) $
<br /> AUTOS ONLY AUTOS
<br /> X HIRED IX
<br /> NON-OWNED PROPERTY DAMAGE $
<br /> AUTOS ONLY AUTOS ONLY Per accident
<br /> Excess per ooclagg $1,000,000
<br /> D UMBRELLA LIAR X OCCUR Y Y 8EA7XL000207903 10/3/2024 1MI2025 EACH OCCURRENCE $10,000,000
<br /> E 011170903 1013/2024 1013/2025
<br /> X EXCESS LIAB CLAIMS-MADE AGGREGATE $10,000,000
<br /> DEO X RFTENTION$ $
<br /> A WORKERS COMPENSATION Y SAWC666825 5/1212025 5112/2026 X STATUTE I I ERH
<br /> AND EMPLOYERS'LIABILITY Y 1 N
<br /> ANYPROPRIETORIPARTNERIFJ(ECUTIVE F—N] N 1 A E.L,EACH ACCIDENT $1,000,000
<br /> OFFICERIMEMBER FXCLUDPD7
<br /> (Mandatory In NH) F.L.DISPASP-EA EMPLOYEE $1,000,000
<br /> If yes,describe under
<br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000.000
<br /> F Professional Liability TER5325879 101312024 10/312025 Each ClaimlAggregate, 10,000.000
<br /> DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required)
<br /> Excess policy#140002058 effective 10103/2024-10/0312025-QBE Ins Corp NAIC#39217-Limits-$5,000,000 part of$10,000,000 Excess of$5,000,000.
<br /> Crime coverage—Federal Insurance Company,NAIC 20281-Policy#J06767825 effective 1 01312 4-1 01312 5;Limit$1,000,000 DED$10,000.Technology Errors
<br /> &Omissions and Cyber Coverage-Coalition Insurance Company NAIC#29530-Policy#C4LR8025767CYBER effective 1013/24-1013/25.Each ClalmIAGG
<br /> $3,000,000 DIED$100,000.
<br /> City of Santa Ana,Its City Council,officers,officials,employees,agents,and volunteers are additional Insureds with respects to general and automobile
<br /> liability,with a written contract.Waiver of Subrogation applies for general and automobile liability and workers compensation In favor of the additional insured,
<br /> with a written contract.Coverage is primary and non-contributory In favor of the additional insured,Notice of Cancellation is 30 days,except 10 days for
<br /> non-payment.
<br /> CERTIFICATE HOLDER APPROVED .,. ....:: ..,.,.-..,.,._..:..:,=.:-..r,r..
<br /> _ _ CANCELLATION
<br /> By Tu Tran Nguyen of 2:15 pm,Jun 09,2.025
<br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> Tu Trarl D39ltaly signed by THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br /> Tate:2 Nguyen 5,06.09 ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> City of Santa AnaNguyen D:15:54207'00'
<br /> 20 Civic Center PI, M-93 1a:,5;5^-°'°°'
<br /> P.O. Box 1988,Attn;Emily Ho;PWA Dev Eng Mgmt Aide AUTHORIZED REPRESENTATIVE
<br /> Santa Ana CA 92702
<br /> ©1988-2015 ACORD CORPORATION. All rights reserved.
<br /> ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD
<br />
|