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AC V CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY)
<br /> 5/1/2026
<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 CONTAC
<br /> Churchill&Associates Insurance Services Inc NAME:
<br /> 31248 Oak Crest Drive, Suite 140 (Atc •805-372-2200 FAX No):
<br /> Westlake Village CA 91361 a'DDRess: certificates churchilirisk.com
<br /> INSURERS AFFORDING COVERAGE NAIC#
<br /> INSURER A:GuideOne Mutual Insurance Company 15032
<br /> INSURED CAFUELS-01 INSURER B:Insurance Company of the West 27847
<br /> AAA Oil, Inc. California Fuels and Lubricants; FOPCO, Inc,11621 Westminster Avenue wsuRERc:General Star Indemnity Company
<br /> Garden Grove CA 92843 IN5URERD:
<br /> INSURER E:
<br /> INSURER F:
<br /> COVERAGES CERTIFICATE NUMBER:591827883 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 SUER POLICY EFF POLICY EXP
<br /> LTR POUCYNUMBER MMIDDIYYYY MMIDDlYYYY LIMITS
<br /> A X COMMERCIAL GPM ERAL LIABILITY Y Y 62P100999-04 5/1/2025 5/1/2026 EACH OCCURRENCE $1,000,000
<br /> DAMAGE TO RENTED
<br /> CLAIMS-MADE Ifl OCCUR PREMISES Ea occurrence $100,000
<br /> MED EXP(Any one person) $0
<br /> PERSONAL&ADV INJURY $1,000,000
<br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000
<br /> X POLICY ff] JECTPRO- LOC
<br /> PRODUCTS-COMPIOPAGG $2,000,000
<br /> OTHER: $
<br /> A AUTOMOBILE LIABILITY 62PI00999-04 511/2025 5/1/2026 COMBINED
<br /> SINGLE LIMIT $1.000,000
<br /> X ANY AUTO BODILY INJURY(Per Person) $
<br /> OWNEAUTOS SCHEDULED BODILY INJURY Per accident) $
<br /> AUTOS ONLY AUTOS (
<br /> X HIRED X NON-OWNED PROPERTY DAMAGE
<br /> AUTOS ONLY AUTOS ONLY Per accident)$
<br /> X CA9948 Pollu X MCS 90 $
<br /> C UMBRELLALIAB X OCCUR IXG671934D 511/2025 5/1/2026 EACH OCCURRENCE $5,000,000
<br /> X EXCESS LIAB CLAIMS-MADE
<br /> AGGREGATE $
<br /> DED I I RETENTION$ I $
<br /> B WORKERS COMPENSATION Y WSD 5060563 05 5/1/2025 5/1/2026 X I S qT E ERH
<br /> AND EMPLOYERS'LIABILITY Y 1 N
<br /> ANYPROPRIETORIPARTNERlEXECUTIVE E.L.EACH ACCIDENT $1,000,000
<br /> OFFICERIMEMBEREXCLUDED? 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 /> A Motor Truck Cargo 62P100999-04 51112025 5/1/2026 Umi1 $50,000
<br /> B USL&H WSD 5060563 05 5/1/2025 5/1/2026 Statutory $1,000,000
<br /> DESCRIPTION OF OPERATIONS I LOCATIONS[VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
<br /> Worksite locations:Various locations in Santa Ana
<br /> Description of Job:Facilities of HVAC,Maintenance and Repairs
<br /> City it's officers,employees,agents,and representatives are Additional Insured as respects to General Liability per attached endorsement form.Waiver of
<br /> Subrogation applies to General Liability and Workers Compensation per attached endorsement farm.
<br /> by Tu Tyslgned APPROVED
<br /> Tu Tran by 7u Tran
<br /> Nguyen
<br /> Nguyen�Zfi26AA�4 By Tu Tran Nguyen at 7:25 am,May 14,2025.
<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: Public Works
<br /> 215 S Center St. AUTHORIZED REPRESENTATIVE
<br /> Santa Ana CA 92703 �� �, �ifal�LrSl4X.5
<br /> ©1988-2015 ACORD CORPORATION. All rights reserved.
<br /> ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD
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