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Client#: 1400052 MIDWETAPI
<br /> ACORD,,, CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY)
<br /> 10/24/2025
<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(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 any rights to the certificate holder in lieu of such endorsement(s).
<br /> PRODUCER CONTACT
<br /> NAME, Lake, CISR
<br /> USI Insurance Services, LLC CL PHONE FAx
<br /> Arc No,Ext:567-803-4414 Arc,No
<br /> 200 N.Saint Clair Street ADDRIEss: Jennifer.Lake@usi.com
<br /> Suite 1400
<br /> INSURER(S)AFFORDING COVERAGE NAIC#
<br /> Toledo, OH 43604 Transportation Insurance Company INSURER A: p p Y 20494
<br /> INSURED INSURER B:Continental Insurance Company 35289
<br /> Midwest Tape, LLC INSURER C:Continental Casualty Company 20443
<br /> P.O. Box INSURER D:Midwest Employers Casualty Company 23612
<br /> Holland, OHH 43528-0820 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 /> CERTIFRCATE 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 /> SUBR
<br /> LTRR TYPE OF INSURANCE NSRL WVD POLICY NUMBER MMIDDYIYEYYY MMIDDYN"n_ LIMITS
<br /> A X COMMERCIAL GENERAL LIABILITY X X 6071847392 5/09/2025 05/09/2026 EACH OCCURRENCE $1,000,000
<br /> CLAIMS-MADE X1 OCCUR PREMISESQ a aNr�°noe $500,000
<br /> OH Stop Gap MFD FXP(Any one person $15,000
<br /> $1mi!$lmil$1mi PERSONAL&ADV INJURY $1,000,000
<br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000
<br /> POLICY I I JE° I LOG PRODUCTS-COMPIOP AGG $2,000,000
<br /> OTHER: $
<br /> A AUTOMOBILE LIABILITY X X 6071847408 05I0912025 05109I202 COMBINED SINGLE LIMIT
<br /> Ea accident $1,000,000
<br /> X ANY AUTO BODILY INJURY(Per person) $
<br /> OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident)
<br /> HIRED NON-OWNED PROPERTY DAMAGE
<br /> X AUTOS ONLY X AUTOS ONLY Per accident $
<br /> g X UMBRELLA LIAB X OCCUR X X 6071847425 0510912025 05/0912026 EACH OCCURRENCE s15,000,000
<br /> EXCESS LIAR CLAIMS-MADE AGGREGATE $15 000 000
<br /> DED I X RETENTION$0 r$1,000,000
<br /> C WORKERS COMPENSATION X 6071847411 5/09/2025 05109/202 X STATUTE EERH
<br /> AND EMPLOYERS'LIABILITY
<br /> D ANY PROPRIETORIPARTNERIEXECUTIVE� X EW000914$ 5/09/2025 05109/202 E.L.EACH ACCIDENT 00
<br /> OFFICER/MEMBER EXCLUDED? f1J N I A
<br /> (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $1,000,000
<br /> If yes,describe under
<br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT
<br /> E Cyber Tech E F15620304006 11/09/2025 11109/2026 $5,000,000!$100K rat
<br /> DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space Is required)
<br /> DlgitAy signed
<br /> TU Tran t,yT Tea
<br /> Nguyen
<br /> The City of Santa Ana, its officers,employees, agents, and representatives are additionally insured . Nguyen°32fiZ02aB,003
<br /> APPROVED
<br /> CERTIFICATE HOLDER CANCELLATION ay Tu Tran Nguyen at.1.25 pm,Jan 13,2026
<br /> City of Santa Ana SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br /> Risk Management Division ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> 20 Civic Center Plaza 4th Floor
<br /> Santa Ana, CA 92702-0000 AUTHORIZED REPRESENTATIVE
<br /> ©1988-2015 ACORD CORPORATION.All rights reserved.
<br /> ACORD 25(2016103) 1 of 1 The ACORD name and logo are registered marks of ACORD
<br /> #S 515267431M51518452 M L KZP
<br />
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