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Docus ig nEnvelope ID:857238AA-774C-436A-973D-821 FBAO BCE6D
<br /> C��R"® CERTIFICATE OF LIABILITY INSURANCE 7E(MMIDDIYYYYI
<br /> l� 113/2025
<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 /> this certificate does not confer rights to the certificate holder in lieu of such endorsements .
<br /> PRODUCER CONTACT NAME: Stefanie Ford
<br /> Coto Insurance&Financial Services PHCN o (805)366-0838 FAX No: (949)858-7301
<br /> 200 S ectrum Center Drive,Ste 150 E-MAIL
<br /> ADDRESS: slefanie@cotoinsurance.com
<br /> P
<br /> INSUREll AFFORDING COVERAGE NAIC#
<br /> Irvine CA 92618 INSURER A: Evanston Insurance Company 35378
<br /> INSURED INSURER B: State Compensation Insurance Fund 35076
<br /> California Forensic Phlebotomy Inc INSURER C:
<br /> 5753 E Santa Ana Cyn Rd.,Suite G-553 INSURER D:
<br /> Anaheim Hills CA 92807 INSURER E
<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 /> ICY EXP
<br /> LTR TYPE OF INSURANCE ADDL SUBR POLPOLICY NUMBER. MMI�DIYYY MMICY EFF DDfYYYY LIMITS
<br /> X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000.00
<br /> v DAMAGE TO RENTED
<br /> CLAIMS-MADE1^1 PREMISES Ea occurrence $ 50,OD0.00
<br /> X PROF LIABILITY-CLAIMS MADE VIED EXP(Any one person) $ 5,000.00
<br /> A X MKLV5PSM001709 11/17/2025 11/17/2026 PERSONAL&ADV INJURY $ 2,000,000.00
<br /> GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 3,000,000.00
<br /> POLICY1:1 PRO ❑ LOC PRODUCTS-COMPIOPAGG s INCLUDED
<br /> -JE
<br /> OTHER $
<br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000,00
<br /> Ea accident
<br /> ANY AUTO BODILY INJURY(Per person) $
<br /> A OWNED SCHEDULED MKLV5PSM001709 11117/2025 11/17/2026 BODILY INJURY(Per accident) $
<br /> AUTOS ONLYH
<br /> AUTOS
<br /> X HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLYAUTOS ONLY Per accident
<br /> UMBRELLA LIAB OCCUR EACH OCCURRENCE $
<br /> EXCESS LIAB h CLAIMS-MADE AGGREGATE $
<br /> DED RETENTION$ $
<br /> WORKERS COMPENSATION �/ PER OTH-
<br /> AND EMPLOYERS'LIABILITY YIN X STATUTE ER
<br /> ANY PRO PRIETORIPARTNERIEXECUTIVE �� E.L.EACH ACCIDENT $ 1,000,000.00
<br /> B OFFICERIMEMBER EXCLUDED? I—f I NIA X 9314557-25 04/1212025 04112/2026
<br /> (Mandatory in NH), E.L.DISEASE-EA EMPLOYEE $ 1,000,000.00
<br /> If yes,describe under
<br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000.00
<br /> E&O1 PER CLAIM 1,000,000.00
<br /> A PROFESSIONAL LIABILITY MKLV5PSM001709 11117/2025 11/1712026 AGGREGATE 3,000,000.00
<br /> DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required)
<br /> City of Santa Ana Risk Management Division and its elected and appointed boards,officers,agents,and employees are named Additional insureds as
<br /> respects to General Liability so long as a written contract or agreement to Such exists with the named insured prior to a loss,as per attached endorsement
<br /> Manuscript-1.
<br /> 30 days Notice of cancellation applies as per attached endorsement MEIL 1249 03 16. Digitally signed
<br /> TU Tran byTuTran
<br /> Nguyen APPROVED
<br /> N U e n Date:2i125.12.03
<br /> Y 09:00:45-0B'o0' 8y Tu Tran Nguyen at 9_00 am,Dec 03,2025
<br /> CERTIFICATE HOLDER CANCELLATION
<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 /> ACCORDANCE WITH THE POLICY PROVISIONS,
<br /> Attn:Police Department
<br /> Traffic Division AUTHORIZED REFIRE S uSigned by:
<br /> 20 Civic Center Plaza,4th floor —1 C -�
<br /> Santa Ana,CA 92701 STEFANIE FORD l�
<br /> O 1988-2015 ACORD CORPORATION. All rights reserved.
<br /> ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD
<br />
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