|
ENVIPLA-02 TAKAPt1K
<br /> TE
<br /> CERTIFICATE OF LIABILITY INSURANCE D 1021I2D 121/20Y5
<br /> 25
<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#OE67768 0,TtCT katalina takapu
<br /> IOA Insurance Services PHONE
<br /> 3875 Hopyard Road (A/C,No,Ext):(925)416-7862 FAX,Nol:(925)416-7869
<br /> Suite 200 E-MAIL
<br /> RESSM
<br /> Pleasanton,CA 94588 INSURER(S)AFFORDING COVERAGE NAIC#
<br /> INSURER A:Continental Casualty Company 20443
<br /> INSURED INSURER13:Hartford Casualty Insurance Company 29424
<br /> Environment Planning Development Solutions Inc dba EPD INSURERC:
<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 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 SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS
<br /> A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 2,000,000
<br /> CLAIMS-MADE � OCCUR X X B6025654530 9130/2025 9/30/2026 OAMAGETORENTEDr $ 1,000,000
<br /> MED EXP(Apy areperson) S 10,00D
<br /> PERSONAL&AQV INJURY S 2,000,000
<br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 4,000,000
<br /> POLICY EC LC 4,0OD,DDOJT -
<br /> OTHER. S
<br /> A AUTOMOBILE LIABILITY COMBINEeD SINGLE LIMIT S 1,000,000
<br /> ANY AUTO X X B6025654530 9/30/2025 9/30/2026 BODILY INJURY PerPerson) S
<br /> OWNED SCHEDULED
<br /> AUTOS ONLY AUTOS BODILY INJURY Per accident S
<br /> XHIRED Ix
<br /> NON-OWNED PROPERTY DAMAGE
<br /> AUTOS ONLY AUTOS ONLY Per accident
<br /> $
<br /> A X UMBRELLA LIAR X OCCUR EACH OCCURRENCE S 4,000,000
<br /> EXCESS LIAR CLAIMS-MADE X X B6025663132 9/3012025 9/30/2026 AGGREGATE s 4,000,000
<br /> LED I X I RETENTION$ 10,000 $
<br /> B WORKERS COMPENSATION X PER OTH-
<br /> AND EMPLOYERS'LIABILITYSTA7Q7E ER
<br /> ANY PROPRIE70R1PAR7NERIEXECU7IVE Y®IN N 1 A X. 57WEGAC2DBW 913012025 913012026 E.L.EACH ACCIDENT S 1,Daa,aOD
<br /> OFFICER/MEMBER EXCLUDED?
<br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE 5 1,000,000
<br /> If yes,describe under 1,Oaa,D00
<br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 5
<br /> A Professional Liab. X EEH591923312 9/30/2025 913012026 Per Claim 4,000,D00
<br /> A]Professional Liab. X EEH591923312 913012025 9/30/2026 Aggregate 5,000,000
<br /> DESCRIPTION OF OPERATIONS I LOCATIONS I 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 Tu Tran Nguyen at 11:78 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 /> Tu Tran 1,yaeaby ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> Tu Tran Nguyen
<br /> Da(e 2025.1022
<br /> Nguyen,is is:57.0r0u
<br /> AUTHORIZED REPRESENTATIVE
<br /> City of Santa Ana,Planning and Building Agency 20 Civic Center Plaza
<br /> ISan 27 1 t�q,
<br /> —�
<br /> ACORD 25(2016103) O 1988-2015 ACORD CORPORATION. All rights reserved.
<br /> The ACORD name and logo are registered marks of ACORD
<br />
|