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HomeMy WebLinkAboutRANESES, MICHAEL (2)INSURANCE ON FILE WORK MAY PROCEED UNTIL IIySUfjPNCE EXPIRES MAYOR CITY CLERK Valerie Amezcua DATE: MAR 0 8 2024 MAYOR PRO TEM Thai Viet Phan COUNCILMEMBERS Phil Bacerra Johnathan Ryan Hernandez Jessie Lopez David Penaloza Benjamin Vazquez (�f tNAVCOA February 14, 2024 Michael Raneses Attn: Michael Raneses PO Box 3124 Tustin, CA 92781 CITY OF SANTA ANA PLANNING AND BUILDING AGENCY 20 Civic Center Plaza . P.O. Box 1988 Santa Ana, California 92702 w .santa-ana.om Re: Extension of Agreement N-2022-041 for Administrative Hearing Services N-2022-041-01 INTERIM CITY MANAGER Tom Hatch CITY ATTORNEY Sonia R. Carvalho CITY CLERK Jennifer L. Hall Pursuant to Section 3 ("Term") of the above -referenced Agreement, entered into by Michael Raneses ("Contractor") and the City of Santa Ana, dated February 18, 2022, the time period of the Agreement is hereby extended for an additional one (1) year period until April 22, 2025. Any insurance certificates are required to be extended and/or renewed to cover this extension. All other terms and conditions of the Agreement remain unchanged and in full force and effect. Sin cereI O o Minh Thai Executive Director, Planning & Building Agency CITY OF SANTA ANA Zw"Alw om dZ.h Interim City Manager APPROVED AS TO FORM k Andrea Garcia -Miller Assistant City Attorney 'rr � MICHAEL RANESES Michael Raneses SANTA ANA CITY COUNCIL Valene Amezwa Thal Viet Phan Benjamin Vazquez Jessle Lor. Phll eaten. Johnalhan Ryan Hernandez oaAd Panaloze Mayor Mayor Pro Tom, WaN 1 Warr2 Wool Ward Wan!5 WxN5 varnzmaAaarlaanaom bhanasenlaana.oro bvazoangWaaAa-ana.om IasalelooeaAsanaana.oro abacenaa,oasnaom Irvanhemantlez®sanlaana nro dmnabz sanla-anaoa N-2022-041-01 Dominguez, Diana From: Dominguez, Diana Sent: Thursday, February 8, 2024 8:44 AM To: Dominguez, Diana Subject: FW: Internal Notice of Compliance From: City of Santa Ana <certificate-request@ctrax.ididata.com> Sent: Monday, February 5, 20244:41 PM To: Villareal, Francine <FVillareal@santa-ana.ore>; mikeraneses@amail.com Subject: Internal Notice of Compliance NOTICE OF COMPLIANCE ( 1"II .S"f-APE: PRIN"1--1IIIS 1, VJI 01) IN( IA DE NA'1"1,11 _ACRE ENIVI, 1 TOTIIE, CIJ RK OI 1111" (COt V IL Contractor Michael Raneses Name: Project N-2022-041 Number: Project Agreement With Michael Raneses To Provide Administrative Hearing Name: Services The Certificate of Insurance (COI) submitted indicates that the coverages comply with the insurance requirements. The compliant coverage(s) are: TYPE OF POLICY NUMBER EXPIRATION COI INSURANCE DATE DATE AUTOMOBILE LIABILITY GENERAL LIABILITY PROFESSIONAL LIABILITY WORKERS COMPENSATION AND EMPLOYERS' LIABILITY WAIVER 11/01/2024 11/13/2023 P1000779647 02/01/2025 12/02/2023 GL_ADDITIONALINSURED_ACORD_TheCityofSant EONCAF155700032005 02/06/2025 02/06/2024 Michael+R WAIVER 09/27/2024 11/13/2023 MI1 1 No further action is required at this time. Thank you, City of Santa Ana Risk Management Division in partnership with CTrax Plus Services Team 2/5/2024 7:41 PM 1 0 ACOR" CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 12/18/2024 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Hiscox Inc. d/b/a/ Hiscox Insurance Agency in CA PHONE FAX A/C No Ext : ($$$) 202-3007 A/C No): 5 Concourse Parkway E-MAIL Suite 2150 ADDRESS: contact@hiscox.com INSURER(S) AFFORDING COVERAGE NAIC# Atlanta GA, 30328 INSURERA: Hiscox Insurance Company Inc 10200 INSURED INSURER B MICHAEL RANESES 2409 MIRA MONTE CT INSURERC: Tustin, CA 92782 INSURER D : INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL I SUBR POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MMIDD/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE � OCCUR DAMAGE TO PREM SES (Ea occurrence) ence) $ 100,000 _7TED MED EXP (Any one person) $ 5,000 PERSONAL BADVINJURY $ 0 A Y P100.077.964.8 02/01/2025 02/01/2026 GEN'LAGGREGATELIMITAPPLIESPER: GENERAL AGGREGATE $ 2,000,000 JPRO- X POLICY LOC PRODUCTS - COMP/OP AGG $ S/T Gen. Agg. $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY (Per person) $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ NON -OWNED HIRED AUTOS AUTOS UMBRELLALIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED I I RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN PER OTH- STATUTE ER ANYPROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT is OFFICER/MEMBEREXCLU DED? ❑ NIA E.L. DISEASE- EA EMPLOYEE $ (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT I $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Tu Tran by TU �yslgned b Tran FAPPROVED Nguyen Nguyen °3�;z02a82a' n Tran Nguyen at 1.:51 pm, Feb 21, 2025 CERTIFICATE HOLDER CANCELLATION City of Santa Ana Planning and Building Department SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 20 Civic Center Plaza ACCORDANCE WITH THE POLICY PROVISIONS. Santa Ana, CA 92701 AUTHORIZED REPRESENTATIVE @ 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD Policy Number: Named Insured: Endorsement Number: Endorsement Effective P100.077.964.8 MICHAEL RANESES 7 02/01 /2025 Hiscox Insurance Company Inc. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - AUTOMATIC STATUS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. Section II — Who Is An Insured is amended to include as an additional insured any per- son(s) or organization(s) for whom you are performing operations or leasing a premises when you and such person(s) or organiza- tion(s) have agreed in writing in a contract or agreement that such person(s) or organiza- tion(s) be added as an additional insured on your policy. Such person or organization is an additional insured only with respect to lia- bility for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by your acts or omissions or the acts or omissions of those acting on your behalf: 1. In the performance of your ongoing opera- tions; or 2. In connection with your premises owned by or rented to you. A person's or organization's status as an addi- tional insured under this endorsement ends when your operations or lease agreement for that additional insured are completed. CGL E5421 CW (02/14) Includes copyrighted material of Insurance Services Office, Inc., with its Page 1 of 1 permission. Policy Number: Named Insured: Endorsement Number: Endorsement Effective P100.077.964.8 MICHAEL RANESES 17 02/01 /2025 Hiscox Insurance Company Inc. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NONCONTRIBUTORY - OTHER INSURANCE CONDITION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. The following is added to the Other Insurance Condition and supersedes any provision to the contrary: Primary And Noncontributory Insurance This insurance is primary to and will not seek contribution from any other insurance available to an additional insured under your policy, pro- vided: 1. you have agreed in a written contract or agreement to add such additional insured to a policy providing the type of coverage af- forded by this policy; and 2. you have agreed in a written contract or agreement with such additional insured that this insurance would be primary and would not seek contribution from any other insur- ance available to the additional insured. CGL E5581 CW (03/16) Includes copyrighted material of Page 1 of 1 Insurance Services Office, Inc., with its permission NIr; 6 U'o Policy Number: Named Insured: Endorsement Number: Endorsement Effective P 100.077.964.8 MICHAELRANESES 18 02/01 /2025 Hiscox Insurance Company Inc. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. MODIFIED WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Section IV — Conditions: You may waive your rights against another party so long as you do so in writing prior to: (i) an offense arising out of your business that caused a "personal and advertising injury"; or (ii) an "occurrence" that caused "bodily injury" or "property damage". CGL E5402 CW (03/10) Page 1 of 1 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Policy Number: Named Insured: Endorsement Number: Endorsement Effective P100.077.964.8 MICHAEL RANESES 21 02/01 /2025 Hiscox Insurance Company Inc. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Oraanization(s) The City of Santa Ana, its officers, officials, employees, and volunteers Information required to complete this Schedule, if not shown above, will be shown in the Declarations. Section II — Who Is An Insured is amended to in- clude as an additional insured the person(s) or organi- zation(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by your acts or omissions or the acts or omis- sions of those acting on your behalf: A. In the performance of your ongoing operations; or B. In connection with your premises owned by or rented to you. CG 20 26 07 04 © ISO Properties, Inc., 2004 Page 1 of 1 PPGE 6 t UNITED SERVICES AUTOMOBILE ASSOCIATION ADDL INFO ON NEXT PAGE MAIL MCH-M-1 1'�4�r RENEWAL OF 1 �r (A RECIPROCAL INTERINSURANCE EXCHANGE) State O 8 0 9 Veh POLICY NUMBER USAX 9800 Fredericksburg Road - San Antonio, Texas 78288 4 4 4 4 r 00186 66 18 U 7101 0 CA CALIFORNIA AUTO POLICY POLICYPERIOD: (12:01 A.M. standard time) RENEWAL DECLARATIONS EFFECTIVE MAR 20 2025 TO SEP 20 2025 OPERATORS 01 MICHAEL EUGENE RANESES ATTACH TO PREVIOUS POLICY Named Insured and Address 03 RUTH L RANESES MICHAEL EUGENE RANESES LTC USA RET 2409 MIRA MONTE CT TUSTIN CA 92782-9000 Description of Vehicle(s)VEH USE* SYM ,,,,_S VVWC�p- VEH TRADE NAME MODEL BODYTYPE MILEAGE IDENTIFICATION NUMBER 08 06 TOYOTA HILNDR 4D 6737 JTEDD21A760154136 P 09 17 TOYOTA HIGHLANDER 4D 8202 5TDKZRFH9HS524448 B The Vehicle(s) described herein is principally garaged at the above address unless otherwise stated.'* wic=work/school; 13=13usiness; F=Farm;P=Pleasure VEH 08 TUSTIN CA 92782-9000 VEH 09 TUSTIN CA 92782-9000 This go icl provides thosecoverages where a premium is s own below. a limits shown may e r duced by policy provisions and may not be combined regardless of the number of vehicles for which a premium is listed unless specifically authorized elsewhere in this Policy. VEH VEH VEH VEH COVERAGES LIMITS OF LIABILITY 08 6-MONTH 09 6-MONTH ("ACV" MEANS ACTUAL CASH VALUE) D=DED PREMIUM D=DED PREMIUM D=DED PREMIUM D=DED PREMIUM AMOUNT $ MOUNT $ I MOUNT $ MOUNT $ PART A — LIABILITY BODILY INJURY EA PER $ 100,000 EA ACC $ 300,000 135.40 189.35 PROPERTY DAMAGE EA ACC $ 100,000 74.81 102.60 PART B - MEDICAL PAYMENTS EA PER $ 2,000 5.26 8.04 PART C — UNINSURED MOTORISTS BODILY INJURY EA PER $ 100,000 EA ACC $ 300,000 60.57 67.60 TOTAL PRE IUM — SEE FOLLOWING PAGE(S) ADDITIONAL INTEREST — EMPLOYER THE CITY OF SANTA ANA, OFFICER, SA TA ANA, CA ADDITIONAL INTEREST — EMPLOYER THE CITY COSTA MESA OFFICERS„ COSTA MESA, CA ADDITIONAL INTEREST — EMPLOYER THE ROSSMOOR COMMUNITY SERVICE, RO SMOO , CA ADDITIONAL INTEREST — EMPLOYER THE CITY OF LAKEWOOD, LAKEWOOD, CA ADDITIONAL INTEREST — EMPLOYER THE CITY OF BUENA PARK, BUENA PARK, CA ENDORSEMENTS: ADDED 03-20-25 — NONE REMAIN IN EFFECT(REFER TO PREVIOUS POLICY)— A073(05) A200CA(01) RSGPCW(01) EXCLUSION OF NAMED DRIVER 5100CA(02) INFORMATION FORMS: NIPFCA (05) 320CA (05) 50CA (05) CADS (05) 40CA (01) 13580 (03) 999CA(20) „08 RMF55 00 9 RMM63 00 In WITNESS WHEREOF, the Subscribers at UNITED SERVICES AUTOMOBILE ASSOCIATION have caused these presents to be signed by their Attorney -in -Fact on this date FEBRUARY 12, 2025 h��) Wayne Peacock 5000 U 07-11 President, USAA Reciprocal Attorney -in -Fact, Inc. 53461-07-11 PPGE 7 t,� UNITED SERVICES AUTOMOBILE ASSOCIATION 1 �r (A RECIPROCAL INTERINSURANCE EXCHANGE) State ICA 0 8 09 vet, POLICY NUMBER V$�11d1® 9800 Fredericksburg Road -San Antonio, Texas 78288 4 4 4 4 r 0 018 6 66 18 U 7101 0 CALIFORNIA AUTO POLICY POLICYPERIOD: (12:01 A.M. standard time) RENEWAL DECLARATIONS EFFECTIVE MAR 20 2025 TO SEP 20 2025 ATTACH TO PREVIOUS POLICY Named Insured and Address MICHAEL EUGENE RANESES LTC USA RET 2409 MIRA MONTE CT TUSTIN CA 92782-9000 Description of Vehicle(s)VEH USE* SYM es er VEH YEAR TRADE NAME MODEL BODYTYPE AN AL MILEAGE IDENTIFICATION NUMBER 08 06 TOYOTA HILNDR 4D 6737 JTEDD21A760154136 P 09 17 TOYOTA HIGHLANDER 4D 8202 5TDKZRFH9HS524448 B The Vehicle(s) described herein is principally garaged at the above address unless otherwise stated. H W/C=Wo k/School; g=Business; F=Fann;P=Pleasure VEH 08 TUSTIN CA 92782-9000 VEH 09 TUSTIN CA 92782-9000 his policy provi es those coverages where a premium is shown below. a units shown may be r duced by policy provisions and may not be combined regardless of the number of vehicles for which a premium is listed unless specifically authorized elsewhere in this policy. COVERAGES LIMITS OF LIABILITY VEH 08 6-MONTH VEH 09 6-MONTH VEH VEH ("ACV" MEANS ACTUAL CASH VALUE) D=DED I PREMIUM D=DED I PREMIUM D=DED PREMIUM D=DED PREMIUM AMOUNT $ MOUNT $ AMOUNTI $ AMOUNT $ PART D — PHYSICAL DAMAGE COVERAGE COMPREHENSIVE LOSS ACV LESS D 50 30.74D 50 68.00 COLLISION LOSS ACV LESS D 50 133.26D 50 397.09 TOWING AND LABOR 8.91 8.91 ***COVERAGES EXCLUDED WHEN ANY VEHICLE CPERATED BY JOY MARIE RA ESES *** VEHICLE TOTAL PREMIUM 448.95 841.59 6 MONTH PREMIUM $ 1290.54 PREMIUM DUE AT INCEPTION. THIS IS NOT A BILL, STATEMENT TO FOLLOW. CA FRAUD ASSESSMENT FEE $ 1.76 THE FOLLOWING COVERAGE(S) DEFINED IN THIS POLICY ARE NOT PROVIDED FOR: VEH 08 — EXTENDED BENEFITS COVERAGE, ENTAL REIMBURSEMENT VEH 09 — EXTENDED BENEFITS COVERAGE, IENTAL REIMBURSEMENT I E08 H RMF55 00 E H 9 RMM63 00 E H E H In WITNESS WHEREOF, the Subscribers at UNITED SERVICES AUTOMOBILE ASSOCIATION have caused these presents to be signed by their Attorney -in -Fact on this date FEBRUARY 12, 2025 h�� Awl Wayne Peacock 5000 U 07-11 President, USAA Reciprocal Attorney -in -Fact, Inc. 53461-07-11 CITY OF SANTA ANA�, ISK ANAGEMENT��`d�ry�� Mamligfng i���anl�of�HUMRURCg,',,, Affidavit of Exemption for Workers' Compensation Insurance I, Michael Raneses / Director hereby affirm under penalty of perjury, the following declaration: certify on behalf of Michael Raneses Administrative Hearings that during the term of my contract for Administrative Hearing services with the City of Santa Ana, I will not employ any person in any manner so as to become subject to the workers' compensation laws of California and agree that if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with the provisions and provide proof of workers' compensation coverage immediately. Date: February 14, 2025 Print Name: Michael Raneses Print Title: Director Signature: Telephone: 714.287.4999 WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. I:\Risk Mgmt\Insurance Requirements\ Affidavit of Exemption for Workers' Compensation Insurance 2021 Michael Raneses • Administrative Hearings PO Box 3124 Tustin, CA 92781 February 14, 2025 City of Santa Ana Risk Management Division 20 Civic Center Plaza Santa Ana, CA 92702 Re: Auto Insurance Requirement Dear City of Santa Ana Risk Management Division: Michael Raneses Administrative Hearings has intent to enter into an agreement with the City of Santa Ana. Throughout the course of this agreement, Michael Raneses Administrative Hearings attests to the following: 1. While vehicles currently owned by Michael Raneses are fully insured, with the City of Santa named as additional insured, Michael Raneses Administrative Hearings will not use/drive any vehicle in the course and scope of the services provided in the agreement/contract. 2. Michael Raneses Administrative Hearings will not use any owned/rented/leased vehicles during the course and scope of the services provided in the agreement/contract. 3. Michael Raneses Administrative Hearings consultants/independent contractors/employees, if any, would utilize their own personal vehicles/non-company owned, borrowed, or rented/leased vehicles for transportation to and from work and if applicable carry their own automobile insurance. By signing below, I, Michael Raneses, attest that I possess the legal authority to enter into an agreement with the City of Santa Ana as well as the legal authority to attest to the statements above. If at any time it is found that Michael Raneses Administrative Hearings is not adhering to any/all statements in this document and has not provided the minimum auto liability insurance coverage of $1 million per occurrence, the contract will be considered null and void and the company will be held fully liable for any and all damages. Michael Raneses Administrative Hearing Officer Michael Raneses Administrative Hearings 714.287.4999 mikeraneses@gmail.com ACORO® CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 12/24/2024 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Chubb Customer Service Center INSURANCE NOODLE LLC-1NSUREON FAX PHONE 866-972-2727 A/C No Ell: (A/C, No): ADDRESS: chubbcsc �uchubb.com 30 NORTH LASALLE ST INSURER(S) AFFORDING COVERAGE NAIC # INSURER A : ACE Fire Underwriters Insurance Company 20702 CHICAGO, 1L, 60602 INSURED INSURER B : INSURER C : Michael Raneses INSURER D : 2409 MIRA MONTE CT INSURER E : INSURER F : TUSTIN CA 92782 COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DDIYYYY) (MMIDDIYYYY) LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS -MADE OCCUR PREMISES (Ea occurrence) $ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY ❑ PRO ❑ LOC JECT PRODUCTS -COMP/OP AGG $ $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMI I (Ea accident) $ BODILY INJURY (Per person) $ ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY =71717=AMAGE$ (Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS -MADE AGGREGATE $ DED I I RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN PER - STATUTE ER E.L. EACH ACCIDENT $ ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ OFFICER/MEMBER EXCLUDED? NIA E.L. DISEASE - EA EMPLOYEE $ (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ Each Claim $1,000,000 A Errors and Omissions EONCAF155700032 02/06/2025 02/06/2026 Aggregate Limit $2,000,000 Retention $1,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) This certificate is issued as a matter of infonnation only and confers no rights upon the certificate holder. This certificate does not amend, extend, or alter the coverage afforded by the policies above. The insurance afforded by the policies described herein is subject to all terms, exclusions, and conditions of such policies. CERTIFICATE HOLDER CANCELLATION City of Santa Ana SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Planning and Building Department THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 20 Civic Center Plaza ACCORDANCE WITH THE POLICY PROVISIONS. Santa Ana, CA 92701 AUTHORIZED REPRESENTATIVE r .. ,.Faset, © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD CHUBBe ACE Fire Underwriters Insurance Company Chubb Errors and Omissions RENEWAL CERTIFICATE Liability Declarations IN CONSIDERATION OF THE PREMIUM FOR THE RENEWAL POLICY IDENTIFIED BELOW, THE INSURER RENEWS THE EXPIRING POLICY FOR THE PERIOD SET FORTH BELOW. THIS POLICY IS A CLAIMS MADE AND REPORTED POLICY. EXCEPT AS OTHERWISE PROVIDED HEREIN, THIS POLICY COVERS ONLY CLAIMS FIRST MADE AGAINST THE INSUREDS AND REPORTED TO THE INSURER DURING THE POLICY PERIOD. PLEASE READ THIS POLICY CAREFULLY. THE LIMITS OF LIABILITY AVAILABLE TO PAY INSURED DAMAGES SHALL BE REDUCED BY AMOUNTS INCURRED FOR CLAIMS EXPENSES. FURTHER NOTE THAT AMOUNTS INCURRED FOR DAMAGES AND CLAIMS EXPENSES SHALL ALSO BE APPLIED AGAINST THE RETENTION AMOUNT. TERMS THAT APPEAR IN BOLD FACE TYPE HAVE SPECIAL MEANING. PLEASE REFER TO SECTION II, DEFINITIONS, OF THE POLICY. This Renewal Certificate renews the below referenced Expiring Policy and grants new Limit(s) of Liability and a new Retention. The terms, conditions and exclusions of the below referenced Expiring Policy, except as otherwise indicated herein or in endorsements attached hereto, apply to the renewal Policy Period. For purposes of coverage afforded during the renewal Policy Period, the term Policy means the Expiring Policy (including endorsements attached thereto), as amended by this Renewal Certificate and any endorsements attached hereto, and "Declarations" or "Declarations Page" means this Renewal Certificate. Renewal Policy Number: EONCAF155700032-0o6 Item i. Named Insured Michael Raneses Principal Address: 2409 Mira Monte Ct Tustin, CA, 92782-9000 Item 2. Policy Period: Renewal of Policy Number (Expiring Policy): Renewed from 12:ol a.m. 02-o6-2025 To 12:ola.m. 02-o6-2026 (Local time at the address shown in Item 1) Item. 3. Limit of Liability (including Claims Expenses) $1,000,000 Each Claim $2,000,000 Aggregate Limit $5,000.00 Disciplinary Proceeding Claims Expenses Aggregate Limit (in addition and Aggregate Limits set forth above) Item 4. Retention $1,000 Each Claim PF-3813oCA (04/17) (AFU) Westchester Binding Page 1 of 3 Item 5. Premium: $940 Item 6. Retroactive Date (if applicable): 09/18/2020 Item 7: Professional Services: See Amendatory Endorsement Definition of Professional Services Amended Item 8: Notice to Company: A. Notice of Claim or Wrongful Act: CHUBB North American Claims PO Box 5122 Scranton, PA 18505-3801 Toll Free: 844-539-3801 Apollo OpsiFNOLp chubb. com B. All Other Notices: Commercial Risk Services 3 Country View Road Third Floor Malvern, PA 19355 Item 9. Optional Extended Reporting Period: A. Additional Premium: l00% of last annual premium. B. Additional Period: 12 months Item lo. Endorsements attached upon Policy effective date: PF38130CA (0417) RENEWAL CERTIFICATE (AFU) PF23111 (0107) ITEM 7. PROFESSIONAL SERVICES AMENDED PF23112 (0807) LIMITS AMENDED RETROACTIVE DATE AMENDED (SPECIFIED LAYER) PF23294c (0310) NETWORK SECURITY OR PRIVACY LIABILITY EXCLUSION PF47760 (0516) UNSOLICITED COMMUNICATIONS EXCLUSION PF42381CA (0417) DEFINITION OF PROFESSIONAL SERVICES AMENDED PF47462CA (0417) MISCELLANEOUS PROFESSIONAL LIABILILTY ENHANCEMENT ENDORESMENT PF48964 (0417) AMENDATORY ENDORSEMENT CALIFORNIA PF18874 (0206) ACE ADVANTAGE MISCELLANEOUS PROFESSIONAL LIABILITY POLICY PF23296a (0708) CONTINGENT BODILY INJURY, PROPERTY DAMAGE ("FOR" PREAMBLE) WITH SUB -LIMIT OF LIABILITY ALL20887 (1006) ACE PRODUCER COMPENSATION PRACTICES & POLICIES ILP001 (0104) U.S. TREASURY DEPARTMENTS' OFFICE OF FOREIGN ASSETS CONTROL ("OFAC") ADVISORY NOTICE TO POLICYHOLDERS PF-3813oCA (04/17) (AFU) Westchester Binding Page 2 of 3 PF46422 (0715) TRADE OR ECONOMIC SANCTIONS ENDORSEMENT PF19061 (1005) SPOUSAL COVERAGE EXTENSION PF19236 (1205) INSURED DEFINITION AMENDED -LEASED, PART TIME, SEASONAL EMPLOYEES PF19806 (0206) ADDITIONAL INSURED (AUTOMATIC PURSUANT TO CONTRACT) PF38981 (0113) FALSE CLAIMS ACT EXCLUSION PF19018 (1005) ARBITRATOR EXCLUSIONS Ccl k11 k (0422) Signatures (All states except OH) ALL21101 (1106) TRADE OR ECONOMIC SANCTIONS ENDORSEMENT Producer Name and No.: INSURANCE NOODLE LLC - INSUREON 3o NORTH LASALLE ST CHICAGO, IL, 6o602 IN WITNESS WHEREOF, the Insurer has caused this Policy to be signed by a duly authorized representative of the Company. DATE: o9/18/2020 Authorized Representative Chubb. Insured' PF-3813oCA (04/17) (AFU) Westchester Binding Page 3 of 3 1. Coverage under this Policy shall extend to Wrongful Acts taking place anywhere in the world, provided that the Claim is made within the jurisdiction, and subject to the substantive laws of the United States of America, Canada, or their territories or possessions. All premiums, limits, retentions, Damages and other amounts under this Policy are expressed and payable in the currency of the United States of America. If judgment is rendered, settlement is denominated, or another element of Damages under this Policy is stated in a currency other than United States of America dollars, payment under this Policy shall be made in United States dollars at the applicable rate of exchange as published in The Wall Street Journal as of the date the final judgment is reached, the amount of the settlement is agreed upon, or the other element of Damages is due, respectively or if not published on such date, the next date of publication of The Wall Street Journal. G. Subrogation In the event of any payment under this Policy, the Company shall be subrogated to the extent of such payment to all the rights of recovery of the Insureds. The Insureds shall execute all papers required and shall do everything necessary to secure and preserve such rights, including the execution of such documents necessary to enable the Company effectively to bring suit or otherwise pursue subrogation rights in the name of the Insureds. H. Action Against the Company and Bankruptcy No action shall lie against the Company. No person or organization shall have any right under this Policy to join the Company as a party to any action against any Insured to determine the liability of the Insured nor shall the Company be impleaded by any Insured or its legal representatives. Bankruptcy or insolvency of any Insured or of the estate of any Insured shall not relieve the Company of its obligations nor deprive the Company of its rights or defenses under this Policy. I. Authorization By acceptance of this Policy, the Named Insured agrees to act on behalf of all Insureds with respect to the giving of notice of Claim, the giving or receiving of notice of termination or non renewal, the payment of premiums, the receiving of any premiums that may become due under this Policy, the agreement to and acceptance of endorsements, consenting to any settlement, exercising the right to the Extended Reporting Period, and the giving or receiving of any other notice provided for in this Policy, and all Insureds agree that the Named Insured shall so act on their behalf. J. Alteration, Assignment and Headings 1. Notice to any agent or knowledge possessed by any agent or by any other person shall not effect a waiver or a change in any part of this Policy nor prevent the Company from asserting any right under the terms of this Policy. 2. No change in, modification of, or assignment of interest under this Policy shall be effective except when made by a written endorsement to this Policy which is signed by an authorized representative of the Company. 3. The titles and headings to the various parts, sections, subsections and endorsements of the Policy are included solely for ease of reference and do not in any way limit, expand or otherwise affect the provisions of such parts, sections, subsections or endorsements. K. Interpretation PF-18874 (02/06) Page 9 of 10 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. Named Insured Michael Raneses Endorsement Number PF198060206 Policy Symbol Policy Number Policy Period Effective Date of Endorsement EON EONCAF155700032- 02-06-2025 to 02-06-2026 02-06-2025 006 Issued By (Name of Insurance Company) ACE Fire Underwriters Insurance Company Additional Insured (Automatic Pursuant to Contract) It is agreed that: Section II, Definitions, subsection I, the definition of Insured, is amended by adding the following: Insured also means any client or customer of the Named Insured, but only if a written contract entered into by the Named Insured specifically requires that such client or customer be added as an additional Insured for professional liability or errors and omissions insurance, and only for Claims (i) first made on or after the effective date of this endorsement and (ii) for vicarious or imputed liability of such client or customer which results from Wrongful Acts committed solely by the Named Insured. The Policy will not provide coverage for any Wrongful Act committed by such client or customer referenced above which is added to this Policy as an additional Insured. 2. Section III, Exclusions, is amended by deleting exclusion E, but solely with respect to Claims asserted by such client or customer referenced above for Wrongful Acts actually or allegedly committed by an Insured in the performance of or failure to perform Professional Services. All other terms and conditions of this Policy remain unchanged. Authorized Representative PF-19806 (02/06) EO Page 1 of 1