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AcoREP CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY)
<br /> lete—I-- 11/12/2025
<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 pollcy(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 CONTNAME:ACT Francisco HOnzura
<br /> Arthur J.Gallagher Risk Management Services, LLC PHONE FAX
<br /> 4201 Westown Parkway M No Ex) A/C No r
<br /> Suite 120 E-MAIL
<br /> francisco honzura@ajg.com
<br /> West Des Moines IA 50266 INSURER(S)AFFORDING COVERAGE NAIC#
<br /> INSURER A:EMC Insurance Companies 21415
<br /> INSURED INSURER B:Employers Mutual Casualty Company 21415
<br /> Elliott Auto Supply Co., Inc INSURER EMCASCO Insurance Company dba Factory Motor Parts 1380 P y 21407
<br /> Corporate Center Curve Suite 200 INSURER D:Twin City Fire Insurance Company 29459
<br /> Eagan MN 55121-1200 INSURERS:
<br /> INSURER F:
<br /> COVERAGES CERTIFICATE NUMBER:464160266 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 /> INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP
<br /> INSD WVD POLICY NUMBER (MMIDDIYYYY) (MM/DD/YYYY) LIMITS
<br /> A X COMMERCIAL GENERAL LIABILITY Y Y 2D39543 11/15/2025 11/15/2026 EACH OCCURRENCE $5,000,000
<br /> CLAIMS-MADE X OCCUR DAMAGE TO RENTED
<br /> PREMISES(Ea occurrence) $1,000,000
<br /> MED EXP(Any one person) $5,000
<br /> PERSONAL&ADV INJURY $5,000,000
<br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $6,000,000
<br /> X POLICY 'i X LOC PRODUCTS-COMP/OP AGG $6,000,000
<br /> OTHER: Properly Damange $2,000,000
<br /> BU AUTOMOBILE LIABILITY Y V 2139543 11/15/2025 11/15/2026 (EeaeadEe0151 NGLE LIMIT $5,000,000
<br /> B X ANY AUTO 2E39543 11/15/2025 11/15/2026 BODILY INJURY(Per person) $
<br /> B 2T39543 11/15/2025 11/15/2026
<br /> OUTOS
<br /> OWNED LY X SCHEDULED 2Z39543 11/15/2025 11/15/2026 BODILY INJURY(Per accident) $
<br /> UTOS
<br /> x HIRED X NON-OWNED PROPERTY DAMAGE
<br /> AUTOS ONLY AUTOS ONLY (Per accident $
<br /> Ded Comp/Collision $1,000
<br /> D UMBRELLALIAB X OCCUR 10HVZBU5CM1 11/15/2025 11/15/2026 EACH OCCURRENCE $10,000,000
<br /> X EXCESS LIAe CLAIMS-MADE AGGREGATE $10,000,000
<br /> DED RETENTION$ - $
<br /> C WORKERS COMPENSATION Y 2N39543 11/15/2025 11/15/2028 X PER
<br /> AND EMPLOYERS'LIABILITY y/N 2P39543 11/15/2025 11/15/2026 STATUTE ER Statutory
<br /> B„13 ANYPROPRIETOR/PARTNER/EXECUTIVE N N/A 2L39543 11/15/2025 11/15/2026 E.L.EACH ACCIDENT $1,000,000
<br /> OFFICER/MEMBEREXCLUDED9 2R39543 11/15/2025 11/15/2026
<br /> (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $1,000,000
<br /> If yes,describe under
<br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000
<br /> B Garage Liability 2E39543 11/15/2025 11/15/2026 Auto Only- Ea Acc $500,000
<br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space Is required)
<br /> RE: Project#A-2019-085 The City of Santa Ana,20 Civic Center Plaza,Santa Ana,California 92702;its officers,employees,agents and volunteers are
<br /> included as Additional Insured under the General Liability policy per form CG7184(10/13)and auto liability policy per form CA7270(03/07)as per written
<br /> contract requirement pursuant to and subject to the policy's terms,definitions,conditions,and exclusion.The insurance provided in the General Liability policy
<br /> is Primary and Non-Contributory and any other insurance shall be excess only,and not contributing per form CG7184(10/13)as per written contract
<br /> requirement pursuant to and subject to the policy's terms,definitions,conditions,and exclusion.Waiver of Subrogation applies to the Additional insureds as
<br /> respects to the General Liability,Auto Liability and Workers Compensation policies, pursuant to and subject to the policy's terms when required in a written
<br /> contract or agreement per form CG7555(4/13),WC000313(4/84),and CA0444(10/13).
<br /> APPROVED
<br /> CERTIFICATE HOLDER CANCELLATION -ay Tu Tran Nguyen af4:08 pm, ar ,
<br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> City of Santa Ana THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br /> Attention:Joaquin Avalos ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> Public Works Agency—Fleet Services
<br /> 215 S Center St, M-83 AUTHORIZED REPRESENTATIVE
<br /> Santa Ana, CA 92703
<br /> USA ��/� C�III
<br /> p'Qsf
<br /> @ 1988-2015 ACORD CORPORATION. All rights reserved.
<br /> ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD
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