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qCCOR"® GATE{MM1DDlYYYY)
<br /> L,,,^� CER a IFICATE OF LIABILITY INSUF�ANCE 12/15/2025
<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(les)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 /> thls certificate does not confer rights to the certificate holder in lieu of such endorsement(s),
<br /> PRODUCER Steven Luu
<br /> NAME:
<br /> SJL Insurance Services Inc (A/C ONE 626 387-6688
<br /> -M No Ext: (AlC.No):
<br /> AIL
<br /> 539 E Garvey Ave ADDRESS: SteYen@sjlins.com
<br /> INSURERS)AFFORDING COVERAGE NAIC#
<br /> Monterey Park CA 91755 INSURER A: JAMES RIVER CASUALTY COMPANY 13685
<br /> INSURED INSURER B: REDWOOD FIRE AND CASUALTY INSURANCE CO 11673
<br /> CALI STATE PAVING INC. INSURER c: CLEAR SPRING PROPERTY&CASUALTY COMPA-6 15563
<br /> 6699 CHADBOURNE AVE INSURER D:
<br /> INSURER E:
<br /> RIVERSIDE CA 92505-2007 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 CONTRACTOR 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 /> LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MMIDDIYYYY) (MMIDDNYYY) LIMITS
<br /> x COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
<br /> CLAIMS-MADE 7 OCCUR PREMISES(Ea aocun•ence) $ 50,004
<br /> MED EXP(Any one person) $ 1,000
<br /> A Y Y 1 00152824-1 03/01/2025 03/01/2026 PERSONAL&ADVINJURY $ 1,000,000
<br /> GFN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000
<br /> �C POLICY jE O LOC PRODUCTS-COMPIOP AGG $ 2,000,000
<br /> OTHER: $
<br /> AUTOMOBILE LIABILITY (Ea accdent) $ 1,000)000
<br /> ANY AUTO BODILY INJURY(Par person) $
<br /> B OWNED SCHEDULED Y Y OIAPM057253-01 04104/2025 04/04/2026 BODILY INJURY(Peraccident $
<br /> X.AUTOS ONLY � AUTOS )
<br /> HIRED NON-OWNED $
<br /> AUTOS ONLY AUTOS ONLY Per accident)
<br /> UMBRELLA LIAR K OCCUR EACH OCCURRENCE $ 2,000,000
<br /> A 4XEXCESS LIAR CLAIMS-MADE 00162180-0 03/12/2025 03/01/2026 AGGREGATE $ 2,000,000
<br /> IED RETENTION$ $
<br /> ORKERS COMPENSATION XC STATUTE EOTH
<br /> R
<br /> 4.ND EMPLOYERS'LIABILITY Y 1 N
<br /> kNY
<br /> C FFICEWMEMBER EXCLUDEDPROPRIETORIPARTNERIEX?ECUTIVE NIA A �, CSWC05049600 06/25/2025 06/25/2026 E.L.EACH ACCIDENT $ 1,000,000
<br /> Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000
<br /> If yes,describe under
<br /> ESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,400,000
<br /> DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached If more space is required)
<br /> CITY OF SANTA ANA,ITS CITY COUNCIL,OFFICIALS,EMPLOYEES,AGENTS,AND VOLUNTEERS ARE TO BE COVERED AS ADDITIONAL INSUREDS ON CONTRACTOR'S AL POLICIES WITH RESPECT TO
<br /> LIABILITY ARISING OUT OV WORK OPERATIONS PERFORMED BY OR ON BEHALF OF CONTRACTOR INCLUDING MATERIALS,PARTS,AND EQUIPMENT FURNISHED IN CONNECTION WITH SUCH WORK
<br /> OR OPERATIONS AND AUTOMOBILES OWNED,LEASED,HIRED,OR BORROWED BY OR ON BEHALF OF CONTRACTOR,ADDITIONAL INSURED STATUS CAN BE PROVIDED IN THE FORM OF AN
<br /> ENDORSEMENT TO CONTRACTOR'S INSURANCE.TEN(10)DAYS PRIOR WRITTEN NOTICE FOR NON-PAYMENT AND THIRTY(30)DAYS PRIOR WRITTEN NOTICE FOR POLICY CANCELLATION SHALL BE
<br /> PROVIDED TO THE CITY. DIgltallysigned
<br /> TU TYan byTuTran
<br /> `Nguyen
<br /> Nguyen o8438200' I
<br /> APPROVED.. :. ,_.....I
<br /> CERTIFICATE HOLDER CANCELLATION ®y ru Tran Nguyen of 8:41 am,Jan 07,202
<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 /> Attention:Public Works Agency
<br /> 20 CIVIC CENTER PLAZA AUTHORIZED REPRESENTATIVE
<br /> CITY HALL-ROSS ANNEX Ste-,-- L-K
<br /> SANTA ANA CA 92701
<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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