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AC" CERTIFICATE OF LIABILITY INSURANCE rATE(MM!°D YYYY)
<br /> 5/6/2025
<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 endorsement(s).
<br /> PRODUCER CONTACT
<br /> Venbrook Insurance Services PHONE CarOla Kin FAX
<br /> 16815 Von Karman Avenue 818-598-8965 Arc No
<br /> Suite 180 ADDREss: ckin venbrock.com
<br /> Irvine, CA 92606 INSURER(S)AFFORDING COVERAGE NAIL#
<br /> www.venbrook.com CA Lic No.OD80832 INSURER A: Hartford Underwriters Insurance Company 30104
<br /> INSURED INSURER B: Travelers Property Casuals Co of Ames 25674
<br /> Monument ROW INSURER c: Underwriters at Lloyds of London 15642
<br /> 8 Cobblestone Court
<br /> Laguna Nigel CA 92677 INSURERD: Scottsdale Insurance Company 41297
<br /> INSURER E: Travelers Excess and Surplus Lines Co 29696
<br /> INSURER F: Travelers Casualty and Surety Co of Amer 31194
<br /> COVERAGES CERTIFICATE NUMBER: 85170368 REVISION NUMBER:
<br /> THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVL 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 /> INSR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER MMID�YIYYYY POLICY
<br /> LIMITS
<br /> LTR
<br /> A V COMMERCIAL GENERAL LIABILITY 72SBABR6LJ2 4/23/2025 4/23/2026 EACH OCCURRENCE $1000000
<br /> CLAIMS-MADE I—A OCCUR PREMISES Ea occu ence $1,000 Q00
<br /> MEO EXP(Any one person) $1Q Q0Q
<br /> V Deductible:none PERSONAL&ADV INJURY $1,000 000
<br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000
<br /> ✓ POUCY JECT C- F-1 LOC PRODUCTS-COMPIOP AGG $2,000,000
<br /> OTHER: S
<br /> A AUTOMOBILE LIABILITY 72SBABR6LJ2 4/23/2025 4/23/2026 CCMBINEDShNGLELIMIT $
<br /> Ea accident 1,000,000
<br /> ANY AUTO BODILY INJURY(Per person) $
<br /> OWNED SCHEDULED BODILY INJURY{Per accident) $
<br /> AUTOS ONLY AUTOS
<br /> HIRED NON-OWNED PROPERTY DAMAGE
<br /> 1�/
<br /> AUTOS ONLY ✓ AUTOS ONLY Per accident
<br /> $
<br /> A / UMBRELLA LIAR OCCUR 72SBABR6LJ2 4/23/2025 4/2312026 EACH OCCURRENCE $5 000 000
<br /> EXCESS LIAR CLAIMS-MADE AGGREGATE $5 00Q 000
<br /> DE❑ I ✓I RETENTION$10,000 $
<br /> B WORKERS COMPENSATION UB2Y3528922442G 4/2312025 4/23/2026 / SPE TATUTE EORH
<br /> AND EMPLOYERS'LIABILITY Y I N
<br /> OFFICEWMEMB REXCLU EXCLUDED ANYPROPIRIETOPJPARTNERIEXECUTIVE � NIA E.L.EACH ACCIDENT $1,000 Ofl0
<br /> (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $1 ()OQO
<br /> If yes,describe under
<br /> DESGRIPTION OF OPERATIONS bale E.L.DISEASE-POLICY OMIT $1 000 000
<br /> C Professional Liability(Claims Made) MPL444730524 4/23/2025 4/23/2026 $3,000,000 Each Claim/Aggregate Limit
<br /> D Professional Liability(Excess} EKS3571668 4/23/2025 4/24/2026 $3,000,000 Aggregate Limit
<br /> E Cyber Liability CYB10809647300 7/24/2025 7/24/2026 $2,000,000/Per Occurrence
<br /> F Crime 108082890 711/2025 7/1/2026 1$25 0001$2 500 ded
<br /> DESCRIPTION OF OPERATIONS I LOCATIONS!VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Digita y slgne
<br /> T
<br /> Tu I ran byTuTrap
<br /> The City,its officers,officials,employees,and volunteers are included as an Additional Insureds with respects Nguyen
<br /> to General Liability.Primary/Non-Contributory and Waiver of Subrogation apply in favor of the Additional Insured when required Nguyen Date:2025.06.23
<br /> by Written and signed contract. Subject to policy terms,conditions,and exclusions. 16:5534-07'00'
<br /> APPROVED
<br /> By Tu Tran Nguyen at 4.55 pm,Jun 23,2025
<br /> CERTIFICATE HOLDER CANCELLATION
<br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> Attention: Public Works Agency, THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br /> City of Santa Ana, CIPIDesign Engineering ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> 20 Civic Center Plaza
<br /> Santa Ana CA 92702, M-36
<br /> AUTHORIZED REPRESENTATIVE
<br /> Jeffrey Lang
<br /> O 1988-2015 ACORD CORPORATION. All rights reserved.
<br /> ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD
<br /> 55170368 1 2025 GL, HNO, UMB, WC, PL I Carcla King 1 5/6/2025 4:48:20 PM (PDT1 I Page 1 of 5
<br /> This certificate cancels and supersedes ALL previously issued certificates.
<br />
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