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ACC) `R� PATE(MMIDD/YYYY) <br /> �� CERTIFICATE OF LIABILITY INSURANCE F1o/o7/zo2s <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 1NSURER(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 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 COME;NTACT Edward Taber <br /> NA <br /> Edward Taber Insurance PHONE 949-421-3493 FAX No. 737 2i 2 6650 <br /> 1312 CHALK LN E-MAIL,,:bORE Edward@Taberinsurance.com <br /> INSURER 3 AFFORDING COVERAGE NAIC# <br /> CEDAR PARK TX 78613-1429 INSURER A: Gotham Insurance Company 25569 <br /> INSURED INSURER B: Capitol Specialty Insurance Corporation 10328 <br /> SLS Property Management Solutions Inc. INSURERC: Westchester Specialty Insurance Services Inc 524126 <br /> 1776 Park Ave Ste 4-271 INSURER D: <br /> INSURER E: <br /> Park City UT 84060 INSURER F: <br /> COVERAGES CERTIFICATE NUMBER: 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 POLICYNUMBER MM DWYYYY MMIDDIYYYY LIMITS <br /> X COMMERCIAL GENERAL LIABILITY 1 <br /> ,000,000 <br /> EACH OCCURRENCE $ <br /> DAMAGERELATE <br /> CLAIMS-MADE x OCCUR PREMISESS(Ea occurrence) $ 100,000 <br /> X WOS MED EXP Any one person $ 5,000 <br /> A X PNC Wording Y Y GL202500023370 07/25/2025 07/25/2026 PERSONAL&ADV INJURY $ 1,000,000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 <br /> X POLICY JEC LOC PRODUCTS-COMP/OPAGG $ 2,000,000 <br /> OTHER: $ <br /> AUTOMOBILE LIABILITY COMBINEOSINOLELIMIT $ <br /> Ea accident <br /> ANY AUTO BODILY INJURY(Per person) $ <br /> OWNED SCHEDULED BODILY INJURY <br /> AUTOS ONLY AUTOS (Per accident) $ <br /> HIRED NON-OWNED PROPERTY DAMAGE <br /> AUTOS ONLY AUTOS ONLY Per accident $ <br /> UMBRELLALIAB OCCUR EACH OCCURRENCE $ 2,000,000 <br /> B X EXCESS LIAB CLAIMS-MADE Y CXS4059150 07/25/2025 07/25/2026 AGGREGATE $ 2,000,000 <br /> DED I I RETENTION$ $ <br /> WORKERS COMPENSATION PER FTH- <br /> AND EMPLOYERS'LIABILITY Y/N STATUTE F"R <br /> ANYPROPRIETORIPARTNERIEXECUTIVE ❑ NIA E.L.EACH ACCIDENT $ <br /> OFFICERIMEMBEREXCLUDE07 <br /> (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ - <br /> If yes describe under <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ <br /> Pollution <br /> ccurrence 11000,000 <br /> C TBA07092025 07/09/2025 07/09/2026 Aggregate 2,000,000 <br /> DESCRIPTION OF OPERATIONS!LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) <br /> Project Information:: Provide On-Call Trash,Weeds,Rubbish&Sanitation Abatement and Board-Up Services for the City of Santa Ana,A-2022-103-01 <br /> City of Santa Ana Risk Management Division,Its Officers,employees,volunteers officials,agents and representatives are named as additional insured as respects general <br /> liability for services provided by the named insured Coverage Is Primary and Nan-Contributory.Certificate holder will be given 30 day cancellation notice in writing If the <br /> above policy Is changed and cancelled. Digitauysigned <br /> TT <br /> u Iran.hy7u Tran <br /> Nguyen <br /> Coverage is primary by forms 150 CIS 20 01 0413,20 37 0413 and MEGL 0241 01 05 16 N 9 Uyen'ate:zazs,tn,c�'- <br /> APPROVED <br /> CERTIFICATE HOLDER CANCELLATION BY Tu Tran Nguyen at 4o:02 am,Oct o7 2"6 <br /> City Of Santa Ana SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> Risk Management Division ACCORDANCE WITH THE POLICY PROVISIONS. <br /> 20 Civic Center Plaza,4lh Floor <br /> Santa Ana Ca 92701 AUTHORIZED/(REPRESENTATIVE <br /> �a��Q�acee� <br /> @ 1988-2015 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD <br /> I <br />