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ENVIPLA-02 TAKAPUK
<br /> A � CERTIFICATE OF LIABILITY INSURANCE DATE 1 120 2YYI
<br /> 10l2112025
<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 /> IfSUBROGATION 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#OE67768 CONEACT katalina takapU
<br /> IOA Insurance Services PHONE FAX
<br /> 3875 Hopyard Road IA1C,No,Extl:(925)416-7862 (Arc,Nol:(925)416-7869
<br /> Suite 200 E-MAIL
<br /> Pleasanton,CA 94588 ADDRESS
<br /> INSURERS AFFORDING COVERAGE NAIC 9
<br /> tNSURERA:Continental Casualty Company 20443
<br /> INSURED INSURER B:Hartford Casual! Insurance Company 29424
<br /> Environment Planning Development Solutions Inc dba EPD INSURER C
<br /> Solutions Inc
<br /> 3333 Michelson Dr.,Suite 500 INSURER D
<br /> Irvine,CA 92612 INSURER E:
<br /> INSURER F:
<br /> COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: 2
<br /> THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMF-D 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 SE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN ISSUBJECTTO ALL THE TERMS,
<br /> EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br /> INSR ADDL SUER POLICY EFF POLICY EXP
<br /> LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER fMMIDWYYYY MMIDDffYYYJLIMITS
<br /> A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 2,000,000
<br /> CLAIMS-MADE ®OCCUR X X B6025654530 9/30/2025 9/30/2026 DAMAGE TSESO R(EaENocrTEDREM s 1,000,000
<br /> MED EXP(Any one erson S 10,000
<br /> PERSONAL&ADV INJURY $ 2,000,000
<br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL.AGGREGATE S 4,000,000
<br /> POLICY r X]JECT LOG PRODUCTS-COMPIOP AGO S 4,000,000
<br /> OTHER,
<br /> S
<br /> A AUTOMOBILE LIABILITY COMBINED aED ent�SINGLE LIMIT S 1,000,000
<br /> ANY AUTO X X B6025654530 9/30/2025 9130/2026 BODILY INJURY Perperson) S
<br /> OWNED SCHEDULED --
<br /> AUTOS ONLY AUTOS BODILY INJURY Per accident S
<br /> XHIRED X NON- WNED PROPERTY DAMAGE
<br /> AUTOS ONLY AUTO ONLY Per accdent 5
<br /> $
<br /> A X UMBRELLA LIAR N
<br /> OCCUR EACH OCCURRENCE $ 4,000,000
<br /> EXCESS LIAR CLAIMS-MADE X }( B6025663132 913012025 9/3012026 AGGREGATE $ 4,000,000
<br /> DED I X I RETENTION$ 10,000
<br /> B WORKERS COMPENSATION X PER OTH-
<br /> AND EMPLOYERS'LIABILITY T R
<br /> ANY PROPRIETORIPARTNERfEXECITIVE Y® EACH ACCIDENT S
<br /> NIA
<br /> X 57WEGAC20BW 913012025 9130l2026 E-L 1,000,000
<br /> OFFICERIMEMBER.EXCLUDED? ,
<br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE S 1,000,000
<br /> If yes,describe under 1,000,400
<br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $
<br /> A Professional Liab, X EEH591923312 9/3012025 9/30/2026 Per Claim 4,000,000
<br /> A Professional Liab, X EEH591923312 9/30/2025 9130/2026 Aggregate 5,000,000
<br /> DESCRIPTION OF OPERATIONS r LOCATIONS f VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
<br /> RE:On-Call Agreement-Agreement No.A-2023-194-03
<br /> As required by Certificate Holder written contract or agreement,in-addition to(if applicable)the governing written contract or agreement:(1)Commercial
<br /> General Liability policy shall include(a)additional insured coverage and contain(b)primary&non-contributory and(c)waiver of subrogation provisions for
<br /> any additional insured;(2)to the extent applicable,Automobile Liability policy shall include(a)additional insured coverage and contain(b)primary&non-
<br /> contributory and(c)waiver of subrogation provisions for any additional insured;(3)to the extent applicable,Commercial Excess Liability policy shall apply
<br /> on a follow-form basis,excess of commercial general liability,automobile liability and employers' liability policy(ies)with such coverage being concurrent
<br /> with underlying insurance;(4)to the extent applicable,Workers Compensation and Employers'Liability policy shall include a waiver of subrogation provision;
<br /> SEE ATTACHED ACORD 101
<br /> CERTIFICATE HOLDER APPROVED CANCELLATION
<br /> By Tar Tran Nguyen at 79:78 am,Oct 22,2025
<br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br /> TLI Tran Diy,elly'rgdny ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> Tu Tran Nguyen
<br /> �1.Z510
<br /> Nguyen 22
<br /> Ng
<br /> uyen,,,.:,,-o-�•oo•
<br /> AUTHORIZED REPRESENTATIVE
<br /> City of Santa Ana, Planning and Building Agency
<br /> 20 Civic Center Plaza
<br /> Ana,CA 92701 r-�
<br /> ACORD 25(2016103) ©1988-2015 ACORD CORPORATION. All rights reserved.
<br /> The ACORD name and logo are registered marks of ACORD
<br />
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