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ACC)P CERTIFICATE OF LIABILITY INSURANCE DATE{MMIDDIYYYY)
<br /> 8/29/2026 8/26/2025
<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 Lockton Companies,LLC CONTACT
<br /> NAME:
<br /> DBA Locklon Insurance Brokers,LLC in CA PHONE FAX
<br /> CA license#OF15767 AIC No.Ext• (AN,No):
<br /> E-MAIL
<br /> 444 W.47th St.,Ste.900 ADDRESS:
<br /> Kansas City MO 64112-1906 INSURERS AFFORDING COVERAGE NAIC
<br /> (616)960-9400 kcasu@lockton.com INSURER A:Zurich American Insurance Company 16535
<br /> INSURED DUDEK INSURER B:American Guarantee and Liab.Ins.Co. 26247
<br /> 1475838 605 THIRD STREET INSURER C:Continental Casuahy Company 20443
<br /> ENCINITAS CA 92024 INSURER D:
<br /> INSURER E;
<br /> INSURER F:
<br /> COVERAGES CERTIFICATE NUMBER: 16765248 REVISION NUMBER: XXXXXXX
<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 /> ILTIR TYPE OF INSURANCE INSD WVD POLICY NUMBER MM DDY EFF MMIDDY� LIMITS
<br /> A X COMMERCIAL GENERAL LIABILITY Y Y GLOO146311 8/28/2025 8/28/2026 EACH OCCURRENCE $ 1 000 000
<br /> CLAIMS-MADE I X L OCCUR PREMISES Ea occurrence $ 100 000
<br /> 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 /> POLICY PRO-
<br /> JECT ® LOC PRODUCTS-COMPIOPAGG $ 2,000,000
<br /> OTHER: $
<br /> A AUTOMOBILE LIABILITY Y Y BAP0146329 8/28/2025 8/28/2026 COMBINED SINGLE LIMIT $
<br /> Ea accidant 1000 000
<br /> X ANY AUTO BODILY INJURY{Per person) $ XXXX�O{�T�
<br /> AUTOSSCHEDULED BODILY INJURY Per accident $
<br /> AUTOS ONLY AUTOS 1 I
<br /> HIRED NON-OWNED PROPERTY DAMAGE
<br /> AUTOS ONLY AUTOS ONLY Per accident $ xxxxxxX
<br /> $ 7ZXXXXXX
<br /> B X UMBRELLA LIAB X. OCCUR N Y AUC0146407 8128/2025 8/28/2026 EACH OCCURRENCE $ 1,000,000
<br /> EXCESS LIAB CLAIMS-MADE AGGREGATE $ 1000000
<br /> DIED I I RETENTION$ $ XXXXXX.X
<br /> A WORKERS COMPENSATION Y X STAT EO.RHy
<br /> AND EMPLOYERS'LIABILITY YIN WC0146330 8/28/2025 8/28/2026 UTE
<br /> ANY PROPRIETORlPARTNERIEXECUTIVE N 1 A E.L.EACH ACCIDENT $ 1,000,000
<br /> OFFICERIMEMBER EXCLUDED?
<br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ 1,000,000
<br /> II yes,describe under
<br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1$ 1 000 000
<br /> C PROFESSIONAL N N EEH591932835 INCL POLL 8/28/2025 8/28/2026 PER CLAIM$2,000,000
<br /> LIABILITY AGGREGATE$2,000,000
<br /> DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required)
<br /> CITY OF SANTA ANA,OFFICERS,AGENTS,EMPLOYEES AND VOLUNTEERS ARE ADDITIONAL INSURED ON GENERAL AND AUTO LIABILITY
<br /> COVERAGE ON A PRIMARY,NON-CONTRIBUTORY BASIS,AS REQUIRED BY WRITTEN CONRACT WAIVER OF SUBROGATION IN FAVOR OF THE
<br /> ADDITIONAL INSURED APPLIES ON WORK COMP,GENERAL,AUTO AND UMBRELLA LIABILITY COVERAGE,AS REQUIRED BY WRITTEN CONTRACT
<br /> AND WHERE ALLOWED BY LAW.COVERAGE IS SUBJECT TO THE TERMS AND CONDITIONS OF THE POLICY.
<br /> APPROVED
<br /> By TO Tran Nguyen at 7.44 am,Sep 02,2A25
<br /> CERTIFICATE HOLDER CANCELLATION See Attachments
<br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> 16765248 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br /> CITY OF SANTA ANA ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> ATTENTION:PUBLIC WORKS AGENCY, AUTHORIZED REPRESENTA
<br /> CTP/DESIGN ENGINEERING ,y
<br /> 20 CIVIC CENTER PLAZA
<br /> SANTA ANA CA 92702,M-36 `�
<br /> O 1988'2015 CORPORATION, All rights reserved.
<br /> ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD
<br />
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