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A C ® R D
<br />DATE(MMMDfyyYY)
<br />CERTIFICATE OF LIABILITY INSURANCE
<br />0610112026
<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
<br />CONTACT Philip Gajic
<br />NAME:
<br />Brown & Brown Retail Insurance Services
<br />AHONN (805) 965-0071 AA (805) 690-3200
<br />Es, No):
<br />ADOREss: Philip.Gajic@bbmwn.com
<br />License #0F56580
<br />1001 Mark Avenue, Suite 201
<br />INSURER(S) AFFORDING COVERAGE
<br />NAIC#
<br />INSURERA: Travelers Property Casualty Company of America
<br />25674
<br />Carpinteria CA 93013
<br />INSURED
<br />INSURERS: Oak River Insurance Company
<br />34630
<br />BKM Office Environments Inc.
<br />INSURER C :
<br />816 Via Alondra
<br />INSURER D :
<br />INSURER E :
<br />Camarillo CA 93012
<br />INSURERF:
<br />COVERAGES CERTIFICATE NUMBER: 26/27 GL BA UMB 25/26 W( 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 INDICATED.
<br />NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE
<br />ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF
<br />SUCH POLICIES. `LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LIMITS SHOWN ARE INCLUSIVE OF AMOUNTS REQUESTED BY THE CERTIFICATE
<br />HOLDER AND MAY NOT REFLECT POLICY LIMIT AMOUNTS IN EXCESS OF THOSE REQUESTED. •Not Applicable In WY
<br />INSR
<br />LTR
<br />TYPE OF INSURANCE
<br />ADOLSUBR
<br />INSD
<br />MD
<br />POLICYNUMBER
<br />POLICY EFF
<br />MMIDDIYYYY)
<br />POLICY EXP
<br />(MIUDD
<br />LIMITS
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE x OCCUR
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />UA MA EIVKLNIEU
<br />PREMISES Eaoccumence
<br />$ 300,000
<br />MED EXP(AM one person)
<br />$ 5,000
<br />OCIP Exclusion
<br />I
<br />PERSONAL& ADV INJURY
<br />$ 1,000,000
<br />A
<br />Y
<br />Y
<br />6308P14384ATI1-26
<br />06/01/2026
<br />06/01/2027
<br />GENT AGGREGATE UM IT APPLIES PER:
<br />POLICY1:1 JECT © LOG
<br />GENERALAGGREGATE
<br />$ 2,000,000
<br />PRODUCTS -COMPIOP AGG
<br />$ 2,000,000
<br />$
<br />OTHER:
<br />AUTOMOBILE
<br />LIABILITY
<br />COMBINED SINGLE LIMIT
<br />Ea azcid.rn
<br />$ 1,000,000
<br />X
<br />BODILY INJURY (Per person)
<br />$
<br />ANVAUTO
<br />A
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />Y
<br />Y
<br />BABP1429342614G
<br />06/01/2026
<br />06/01/2027
<br />BODILY INJURY (Per acci4en0
<br />$
<br />HIRED NON-0WNED
<br />AUTOS ONLY AUTOS ONLY
<br />PROPERTY DAMAGE
<br />Per azcident
<br />$
<br />two
<br />$
<br />X
<br />UMBRELLA LIAR
<br />v
<br />X
<br />OCCUR
<br />EACH OCCURRENCE
<br />$ 5,000,000
<br />AGGREGATE
<br />$ 5,000,000
<br />A
<br />EXCESS UAB
<br />CLAIMS -MADE
<br />CUP8P1481102614
<br />06/01/2026
<br />06/01/2027
<br />DED
<br />RETENTION $
<br />$
<br />WORKERS COMPENSATION
<br />X PER OTH-
<br />R
<br />AND EMPLOYERS'LIABILITY YIN
<br />ANVCERIMEMBEREXCLUDED? CUTIVE
<br />OFFICERIMEMBER EXCLUDED?
<br />Iin NH)
<br />NIA
<br />Y
<br />BKWCfi41667
<br />12130/2025
<br />12/30/2026
<br />STATUTE ER
<br />E.L. EACH ACCIDENT
<br />$ 1,000,000
<br />E.L. DISEASE-EAEMPLOYEE
<br />$ 1,000,000
<br />fyes,dory
<br />Dyes, describe under ow
<br />DESCRIPTION OF OPERATIONS balm
<br />EL. DISEASE -POLICY LIMIT
<br />$ 1,000,000
<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, Community Development Agency, are included as Additional Insured under the General Liability per the attached form CG D2 46 04 19
<br />and under the Auto Liability per the attached form CAT3 53 0215. as required per written contract. General Liability is Primary and Non Contributory per the
<br />attached form CG Tt 00 02 19, ad required per written Contract. Waiver of Subrogation applies to the General Liability per the attached for CG 24 04 1219,
<br />Auto Liability per the attached form CA 04 4410 13, and Workers Compensation per the attached form WC 99 04 10 C (Ed.01-19), as required per written
<br />contract.
<br />APPROVED
<br />By TVT@nJ4s-um,at2;3LPm,-,( : t1-
<br />CERTIFICATE HOLDER
<br />CANCELLATION
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />City of Santa Ana, Community Development Agency
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />Housing Autonty M-27
<br />AUTHORIZED REPRESENTATIVE
<br />20 Civic Center Plaza
<br />Santa Ana CA 92701
<br />t,&ft1/JII.DYI>Z�
<br />ACORD 25 (2025112) 01988-2025 ACORD CORPORATION. All rights reserved.
<br />The ACORD name and logo are registered marks ofACORD
<br />
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