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Al4 Q' g V CERTIFICATE OF LIABILITY INSURANCE F DATE(MMIDDIYYYY)10/9/2025
<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 /> Inszone Insurance Services, LLC PHONE In
<br /> Team FAX
<br /> 2721 Citrus Road, Suite A E 877-308-9663 Arc No:916-400-2625
<br /> Rancho Cordova, CA 95742 AooR€ss: cerls inszoneins,com
<br /> INSURERS AFFORDING COVERAGE NAIC#
<br /> License#_OFa2764 INSURER A:General Insurance Company of America 24732
<br /> INSURED INTEING-15 INSURER B: Insurance Company of the West 27847
<br /> Inter-Pacific, Inc.
<br /> 39 Peters Canyon Road INSURERC:West American Insurance Company 44393
<br /> Irvine, CA 92606 INSURERD:
<br /> INSURER E:
<br /> INSURER F:
<br /> COVERAGES CERTIFICATE NUMBER:1979646451 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 /> INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP
<br /> LTR POLICY NUMBER MMI6DIYYYY mnTirf" LIMITS
<br /> C X COMMERCIAL GENERAL LIABILITY Y Y BKW62698905 91812025 9/8/2026 EACH OCCURRENCE S 1,000,000
<br /> CLAIMS-MADE OCCUR DAMAGE TO RENTED
<br /> PREMISES Ea occurrence 5 500,000
<br /> MED EXP{Any one person) S 15,000
<br /> PERSONAL&ADV INJURY S 1,000,000
<br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 2,000,000
<br /> POLICY❑ PRO- ❑ LOC PRODUCTS-COMPIOP AGG S 2,000,000
<br /> X JECT
<br /> OTHER: S
<br /> A AUTOMOBILE LIABILITY Y Y AZG62698905 9/8/2025 9/812026 COMBINED SINGLE LIMIT S 1,000,000
<br /> Ea accident
<br /> X ANY AUTO BODILY INJURY(Per person) S
<br /> OWNED SCHEDULED BODILY INJURY(Per accident) S
<br /> AUTOS ONLY AUTOS
<br /> X HIRED X NON-OWNED PROPERTYOAMAGE S
<br /> AUTOS ONLY ALTOS ONLY Per accident
<br /> S
<br /> UMBRELLALIAB OCCUR EACH OCCURRENCE $
<br /> EXCESS LIAB CLAIMS-MADE AGGREGATE $
<br /> DED RETENTION$ $
<br /> H WORKERS COMPENSATION Y WSA 5084780 00 6/912025 6/9/2025 X PER IR
<br /> AND EMPLOYERS'LIABILITY �,1 N STATUTE EFR
<br /> ANYPROPRIETORIPARTNERIEXECUTIVE ("] E.L.EACH ACCIDENT $1,000,000
<br /> OFFICERIMEMBEREXCLUDED? u NIA
<br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1.000,000
<br /> If yes,describe under
<br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000
<br /> DESCRIPTION OF OPERATIONS I LOCATIONS)VEHICLES ACORD 101,Additional Remarks Schedule,maybe attached if more space is required)
<br /> RE:All CA Operations performed by the Named Insured.
<br /> The City of Santa Ana,its officers,officials,employees and volunteers are included as Additional Insured,with Primary/Non-Contributory and Waiver of
<br /> Subrogation,as respects to General Liability and Auto Liability,per Forms CG 88 10 04 13.CG 85 83 04 13 and AC 00 33 10 21.Waiver of Subrogation applies
<br /> to Workers'Compensation per form WC 99 06 34 When required by Written Contact.
<br /> Tu Tran Ofgitally signed by
<br /> Tu Tr Nguyen
<br /> Nguyen APPROVED
<br /> [By Tu Tran Nguyen at 9:52 am,Oct 13,2025
<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 /> Attn: PWA-PFFR
<br /> 20 Civic Center Plaza, M-21 AUTHORIZED REPRESENTATIVE
<br /> Santa Ana, CA 92701 f
<br /> ©1988-2015 ACORD CORPORATION. All rights reserved.
<br /> ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD
<br />
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