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7ATE,(MMIDDfYYYY)
<br /> ACORO° CERTIFICATE OF LIABILITY INSURANCE26/2026
<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 NAME Shannon Balo
<br /> Number1 Insurance Marketing Services PHONE FAX
<br /> 17111 Beach Blvd Ste 103 A/c No Ext: (714)848-4400 A/C No): (714)848-3500
<br /> Huntington Beach, CA 92647 E-MAIL
<br /> E-MAIL ADDRESS: Shannon@number1ins.com
<br /> License #: OC17917 INSURER(S)AFFORDING COVERAGE NAIC#
<br /> INSURERA: Associated Industries Insurance Company
<br /> INSURED INSURER B: California Automobile Ins 38342
<br /> A 2 Z CONSTRUCT INC INSURERC: Nautlus Insurance Company
<br /> 63 VIA GATILLO INSURER D: State Compensation Insurance Fund
<br /> RANCHO SANTA MARGAR, CA 92688-3160 INSURERE: Colony Insurance Company
<br /> INSURER F:
<br /> COVERAGES CERTIFICATE NUMBER: 00004613-0 REVISION NUMBER: 55
<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 LIMITS
<br /> LTR INSD WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY
<br /> A X COMMERCIAL GENERAL LIABILITY Y Y AES1268943 00 11/23/2025 11/23/2026 EACH OCCURRENCE $ 1,000,000
<br /> CLAIMS-MADE J OCCUR PREM AGE SESOEa occuRENTErrDence $ 100,000
<br /> MED EXP(Any one person) $ 2,500
<br /> PERSONAL&ADV INJURY $ 1,000,000
<br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000
<br /> �( POLICY D PRO-
<br /> JECT LOC PRODUCTS-COMP/OP AGG $ 2,000,000
<br /> OTHER: $
<br /> MBIB AUTOMOBILE LIABILITY Y Y BA040000086557 02/15/2025 02/15/2026 EOa a.,deDtsINGLE LIMIT $ 1,000,000
<br /> ANY AUTO BODILY INJURY(Per person) $
<br /> OWNED SCHEDULED BODILY INJURY(Per accident) $
<br /> AUTOS ONLY X AUTOS
<br /> HIRED NON-OWNED PROPERTY DAMAGE $
<br /> X AUTOS ONLY X AUTOS ONLY Per accident
<br /> `` UMBRELLA LAB X OCCUR AN1367841 11/23/2025 11/23/2026 EACH OCCURRENCE $ 4,000,000
<br /> X EXCESS LABCLAIMS-MADE AGGREGATE $ 4,000,000
<br /> DED I I RETENTION$ 0 $
<br /> D AND EMPS YERS'LSA IONILIT Y 9392821 12/31/2025 12/31/2026 X STATUTE EERH
<br /> AND EMPLOYERS'LIABILITY
<br /> ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT $ 1,000,000
<br /> OFFICER/MEMBER EXCLUDED? Fy] N/A
<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 /> E Pollution CSP4245644 07/10/2025 07/10/2026 General Aggregate 2,000,000
<br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached if more space is required)
<br /> City of Santa Ana, its City Council, officers,officials, employees, agents, and volunteers are named additional insured with
<br /> regards to CGL and commercial Auto per policy when required by written contract with the insured. Primary and non
<br /> contributory wording shall be afforded by the policy to the additional insured.Waiver of subrogation shall be afforded by the
<br /> CGL, commercial Auto and WC policy in favor of the additional insured.
<br /> APPROVED
<br /> CERTIFICATE HOLDER CANCELLATION By Tu Tran Nguyen at 7:50 am,Jan 27, 2026
<br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> City of Santa Ana THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN
<br /> PWA— Park Services ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> 220 S Daisy Ave AUTHORIZED REPRESENTATIVE
<br /> SANTA ANA, CA 92703
<br /> (SSB)
<br /> ©1988-2015 ACORD CORPORATION. All rights reserved.
<br /> ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Printed by SSB on 01/26/2026 at 04:39PM
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