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G OLDGAT-25 AJ OO
<br /> '4� © CERTIFICATE OF LIABILITY INSURANCE FDATE(M 1122/2026YY,
<br /> 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 License#0757776 CONTACT Anna Joo
<br /> NAME:
<br /> HUB International Insurance Services Inc. PHONE FAX --
<br /> 9122 Garden Grove Blvd faro,No,Ext):(714)590-3508 (A/C,Noy;
<br /> Garden Grove,CA 92844 ADDRESS:anna.joo@hubinternational.com
<br /> INSURERtS)AFFORDING COVERAGE NAIC tf
<br /> INSURER A:Gemini Insurance Company 410833
<br /> INSURED INSURERS:California Automobile Insurance Company 38342 _
<br /> Golden Gate Steel,Inc.DBA Golden Gate Construction INSURER C:Insurance Company of the West 27847
<br /> — --
<br /> 14709 Carmenita Rd. INSURER D;Starstone Specialty Insurance Company 44776
<br /> Norwalk,CA 90650 INSURER E:Westchester Surplus Lines Insurance Co. 10172
<br /> 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 SUER MPMLDDY EFF I POLICY EXP LIM9T5
<br /> L IN POLICY NUMBER
<br /> A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
<br /> CLAIMS-MADE X OCCUR VIGPO29732 1131/2025 1/3112026 DAMAGE TO RENTED 100,00()
<br /> f X X PREMISES Ea occurrence $
<br /> MFD EXP(Any oneperson) $ 5,0ao
<br /> PERSONAL&ADVINJURY $ 1,000,000
<br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000
<br /> POLICY LAI P ❑ LOC PRODUCTS-COMPIOPAGG_ $ 2,000,000
<br /> OTHER: j $
<br /> AUTOMOBILE LIABILITY COM BINED SINGLE LIMIT 1,000,000Ea accident $
<br /> X ANY AUTO X X !BA040000028522 712112025 7/2112026 BODILY INJURY Perperson) $
<br /> OWNER SCHEDULED
<br /> AUTOS ONLY AUTOS BODILY INJURY Per accident S
<br /> HIRED NON-OWNED PRROPERTY AM GE
<br /> AUTOS ONLY AUTOS ONLY Per accident $
<br /> �.. $
<br /> A UMBRELLA LAB X OCCUR EACH OCCURRENCE$ 2,000,000
<br /> X EXCESS LIAB CLAIMS-MADE X X IVIFX003705 1131/2025 1/3112026 AGGREGATE I $ 2,060r000
<br /> OED RETENTION$ —
<br /> C WORKERS COMPENSATION I I X PER DTH-
<br /> AND EMPLOYERS'LIABILITY Y f N V STATUTE ER
<br /> ANY PROPRIETaR1PARTNERr1=xFcuTIVF X WVE 5083464 00 4117/2025 4/17/2026 1,000,000
<br /> 1 FFICERIMEMBFR EXCLUDED? N f A E.L.EACH ACCIDENT $
<br /> (Mandatory in NH) 1,000,000
<br /> E.L.DISEASE-EA EMPLOYE $
<br /> If yes,describe under
<br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000
<br /> D Excess Liability-2nd B75620240ALI 111112024 1/3112026 ;Each Occurrence 2,000,000
<br /> E Pollution Liability G49668909 001 1/2612026 112612/127 Each Condition 2,000,000
<br /> DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required(
<br /> Project Name:.Portola Splash Pad Project
<br /> Job Site Address: 1700 E.Santa Clara Ave,Santa Ana,CA 92701
<br /> City of Santa Ana,its City Council,its officers,officials,employees,agents,and volunteers are named as Additional Insureds with respect to General Liability
<br /> &Auto Liability when agreed in written contract.Waiver of Subrogation in favor of City of Santa Ana,its City Council,its officers,officials,employees,agents,
<br /> and volunteers on General Liability,Auto Liability and Workers Compensation when agreed in written contract.General Liability&Auto Liability coverage is
<br /> Primary&Non-Contributory when agreed in written contract.10 days cancellation notice for non-payment of premium.30 days cancellation notice for all
<br /> other.
<br /> SEE ATTACHED ACORD 101 APPROVED
<br /> CERTIFICATE HOLDER CANCELLATION By Charlene R.Muro at 2:45 pm,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 /> ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> Risk Management Division
<br /> 20 Civic Center Plaza
<br /> Santa Ana,CA 92701 AUTHORIZED REPRESENTATIVE
<br /> REPRESENTATIVE
<br /> ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved.
<br /> The ACORD name and logo are registered marks of ACORD
<br />
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