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A��0 DATE IMMIDDIYYYY)
<br /> AC� CERTIFICATE OF LIABILITY INSURANCE F612 312 0 2 5
<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 endorsement(s).
<br /> PRODU NAMEI
<br /> CER CONTACT
<br /> The Baldwin Group West, LLC PHONE Karlee Crowe FAX
<br /> 15901 Red Hill Ave, Ste 100 1 N, 11714 505-7000 arc No: 714 573-1770
<br /> Tustin CA 02780 EDDRii Karlee.Crowe@baldA(in.com
<br /> INSURERS AFFORDING COVERAGE NAIC#
<br /> Lice ee#:OF69771 INSURERA:BITCO General Insurance Cor or 20006
<br /> INSURED PALPINC-01Pal INSURERB:Great American Insurance Coma 16691
<br /> 223 0 Lemon Avenue Inc, DBA Excel Paving INSURERC:Indian Harbor Insurance Com an 36940
<br /> 23
<br /> Long Beach CA 90806 INSURER D:SlriusPoint Specialty Insuranc 16820
<br /> INSURERS:RSUI Indemnity Company 22314
<br /> INSURER F:
<br /> COVERAGES CERTIFICATE NUMBER.252538607 REVISION NUMBER:
<br /> THIS IS TO CERTIPY 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 /> ILTK TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP
<br /> POLICY NUMBER MMIDDrVYYY MMIDD1YYYY LIMITS
<br /> A X COMMERCIALGENFRALLIABILITY Y Y CLP3768664 6/1/2025 611/2026 EACHOCCURRENCE $1,000,000
<br /> CLAIMS-MADE OCCUR DAMA P T RENTED
<br /> PREMISES Ea occurrence $300,000
<br /> MED EXP(Any one arson) $10,000
<br /> PERSONAL&ADV I NJURY $1,000,000
<br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000
<br /> POLICY[K PE'' LOC PRODUCTS-COMPIOPAGG $2,000,000
<br /> OTHER: EB Aggregate $2,000,000
<br /> A AUTOMOSILE LIABILITY Y Y CAP3758662 611/2025 6/1/2026 COMBINED SINGLELIMIT $1,000,000
<br /> Ea accdent
<br /> X ANY AUTO BODILY INJURY(Per person) $
<br /> OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) $
<br /> X HIRED X NON-OWNED PROPERTY pAMAGE
<br /> AUTOS ONLY AUTOS CNLY Per accident $
<br /> B UMBRELLALIAB X OCCUR TUE341439505 6/1/2025 6/112026 EACH OCCURRENCE $5,000,000
<br /> X EXCESS LIAB CLAIMS-MADE AGGREGATE $5,000,000
<br /> DIED RETENTION$ $
<br /> A WORKERS COMPENSATION Y WC 3758666 6/1/2025 6MI2026 X PER OTH-
<br /> AND EMPLOYERS'LIABILITY Y 1 N STATUTE ER
<br /> ANYPROPRIETORJPARTNER/EXECUTIVE ❑ N 1 A E.L.EACH ACCIDENT $1,000,000
<br /> OFFICERIMEMBER EXCLUDED?
<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 /> C Professional Liability CPPL D0002424 00 6/1/2025 6!1/2026 Occurance 2,000,000
<br /> D Polluifon Liability CPPL D0002424 00 6/1/2025 6/1/2026 Occurance/Aggregate 5,000,000
<br /> E 2nd Layer of Excess NHA606876 611/2025 6/1/2026 XSO-JAgg 1.000,000
<br /> DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached if more space Is required)
<br /> The Certificate Holder is listed as additional insured for the General Liability and Auto Liability.See Attached Endorsements,
<br /> This insurance shall apply as Primary and Nan-Contributory per attached endorsement.
<br /> Waiver of Subrogation for General Liability,Auto liability and Workers'Compensatlon:See Attached Endorsements,
<br /> Cancellation:
<br /> 'Except 10 Days Notice of Cancellation for Non-Payment of Premium.
<br /> "Should this policy be cancelled before the expiration date a 30(thirty)days written notice to those Certificate Holders which require such action per contract Or
<br /> agreement,*
<br /> See Attached...
<br /> CERTIFICATE HOLDER -AppIOVFtr CANCELLATION
<br /> By TuTTan Nguyen at 3 ff0 prn;'Jun 73;'7t173
<br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br /> Tu Tfa n Digitally signed by ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> City of Santa Ana Tu Tran Nguyen
<br /> Public Works Agency M-83 bate;2025.05.23
<br /> 20 Civic Center Plaza Nguyen 15,OOk43-07'00' AUTHORIZED REPRESENTATIVE
<br /> Santa Ana CA 92701
<br /> Oa 1988-2015 ACORD CORPORATION. All rights reserved.
<br /> ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD
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