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712/18/2025
<br /> E(MM/DD/YYYY)
<br /> ACOR" CERTIFICATE OF LIABILITY INSURANCE
<br /> ��
<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 /> NAME:
<br /> Digital Insurance LLC-Clayton, MO PHONE FAX
<br /> 8235 Forsyth Blvd#1200 A/C No Ext: 314-746-4700 A/C,No:314-889-3700
<br /> Clayton MO 63105 ADDRESS:
<br /> INSURER(S)AFFORDING COVERAGE NAIC#
<br /> License#:8012081 INSURERA: National Fire Ins Co Of Hartford 20478
<br /> INSURED ADMIINC-01 INSURERB: Continental Insurance Company 35289
<br /> AdminSure, Inc.
<br /> 3380 Shelby St INsuRERc: Hartford Fire Ins Co 19682
<br /> Ontario CA 91764 INSURERD: Evanston Ins Co 35378
<br /> INSURERE: QBE Specialty 11515
<br /> INSURER F:
<br /> COVERAGES CERTIFICATE NUMBER:1092020042 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 LIMITS
<br /> LTR INSD WVD POLICY NUMBER MM/DD MM/DD
<br /> A X COMMERCIAL GENERAL LIABILITY Y Y 7036373730 1/1/2026 1/1/2027 EACH OCCURRENCE $1,000,000
<br /> CLAIMS-MADE � OCCUR PREMISES DAMAGE TO
<br /> PREMISES Ea occurrence)
<br /> ccurrence $100,000
<br /> MED EXP(Any one person) $15,000
<br /> PERSONAL&ADV INJURY $1,000,000
<br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000
<br /> POLICY� PRO- � LOC PRODUCTS-COMP/OP AGG $2,000,000
<br /> OTHER: $
<br /> A AUTOMOBILE LIABILITY Y Y 7036373744 1/1/2026 1/1/2027 COMBINED SINGLE LIMIT $1,000,000
<br /> Ea accident
<br /> ANY AUTO BODILY INJURY(Per person) $
<br /> OWNED SCHEDULED BODILY INJURY(Per accident) $
<br /> AUTOS ONLY AUTOS
<br /> X HIRED X NON-OWNED FIR ERTYDAMAGE $
<br /> AUTOS ONLY AUTOS ONLY Per accident
<br /> B X UMBRELLALIAB X OCCUR 7036373761 1/1/2026 1/1/2027 EACH OCCURRENCE $6,000,000
<br /> EXCESS LAB CLAIMS-MADE AGGREGATE $6,000,000
<br /> DED X RETENTION$1 n nnn $
<br /> C WORKERS COMPENSATION Y 84WEBC3WUM 1/1/2026 1/1/2027 X PER OTH-
<br /> AND EMPLOYERS'LIABILITY Y/N STATUTEI ER
<br /> ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $1,000,000
<br /> OFFICE R/M EMBER EXCLUDED? ❑ 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 /> D Professional Liability MKLV7PE0004322 1/1/2026 1/1/2027 Each Claim/Agg 5,000,000
<br /> E Cyber Liability CELP001940274826300 1/1/2026 1/1/2027 Each Claim/Agg 4,000,000
<br /> Digitally signed
<br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached if more space is required) Nguyen
<br /> Crime Liability Insurer: Atlantic Specialty Insurance Company Nguyen Date:2025.12.24
<br /> Policy No: MML0092160126 08:44:40-08'00'
<br /> Effective Dates: 1/1/2026-1/1/2027
<br /> Per Occurrence Limit: $2,000,000
<br /> City of Santa Ana, its City Council,officers,officials,employees,agents,and volunteers are named additional insured as respects General Liability and
<br /> Automobile Liability.Waiver of Subrogation is applicable as respects General Liability,Auto Liability,and Workers Compensation.
<br /> APPROVED
<br /> CERTIFICATE HOLDER CANCELLATION By Tu Tran Nguyen at 8:43 am,Dec 24,2025
<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: Human Resources Dept
<br /> 20 Civic Center Plaza AUTHORIZED REPRESENTATIVE
<br /> Santa Ana CA 92701
<br /> USA
<br /> ©1988-2015 ACORD CORPORATION. All rights reserved.
<br /> ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD
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