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DOMNGEN-01 SMILIK
<br /> CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY)
<br /> 412112026
<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 CONTACT Sarah Mlllk
<br /> NAME:
<br /> Mllik&Associates Insurance Services Inc. PHONE FAX
<br /> 917 S.Village Oaks Dr. (AIC,No,Ext): (AIC,No):
<br /> Covina91724 E-MAIL RESS:sarahIilikinsurance.com
<br /> INSURERS)AFFORDING COVERAGE NAIL#
<br /> INSURERA:Scottsdale Insurance Co 41297
<br /> INSURED INSURERB:California Automobile Insurance Company-CA 38342
<br /> Dominguez General Engineering, Inc. INSURERC:Landmark American Insurance Co 33138
<br /> 11096 Pipeline Ave INSURERD:Everest Premier Insurance Co 16045
<br /> Pomona,CA 91766 INSURER E:Travelers Casualty Insurance Company of Americ 19046
<br /> INSURER F:
<br /> COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
<br /> THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TOTHE 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 /> LTR INSR WVD MMIDDIYYYY MMIDDIYYYY
<br /> A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
<br /> CLAIMS-MADE X OCCUR BCS2003328 12/15/2025 12/15/2026 DAMAGE TO RENTED 100 000
<br /> X X PREMISES Ea occurrence $
<br /> MED EXP(Any one person) $
<br /> PERSONAL&ADV INJURY $ 1,000,000
<br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE $ 2,000,000
<br /> POLICY �PPO_ LOC PRODUCTS-COMP/OPAGG $ 2,000,000
<br /> OTHER $
<br /> B AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000
<br /> Ea accident)$
<br /> ANY AUTO X X BA040000096767 11/20/2025 11/20/2026 BODILY INJURY(Per person) $
<br /> OWNED X SCHEDULED
<br /> AUTOS ONLY AUTOS BODILY INJURY Per accident $
<br /> AUTOS ONLY AUTOS 0�� (PerraccidentDAMAGE $
<br /> C UMBRELLA OCCUR EACH OCCURRENCE $ 5,000,000
<br /> X EXCESS CLAIMS-MADE LHA610144 12/15/2025 12/15/2026 AGGREGATE $ 5,000,000
<br /> DIED RETENTION$ $
<br /> D WORKERS COMPENSATION X PER OTH-
<br /> AND EMPLOYERS'LIABILITY STATUTE ER
<br /> ANY PROPRIETORfPARTNERfEXECUTIVE YIN X 7600026376251 10/1/2025 10/1/2026 1,000,000
<br /> E.L.EACH ACCIDENT
<br /> OFPICERfMEMBER EXCLUDED? N f A $
<br /> (Mandatory in NH) EL DISEASE-EA EMPLOYEE $ 1,000,000
<br /> If yes,describe under 1,000,000
<br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $
<br /> A Commercial Umbrella XLS2008902 12/15/2025 12/15/2026 Limit 4,000,000
<br /> E Inland Marine 660B9908610 10/1/2025 10/1/2026 Location Limit 700,000
<br /> DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
<br /> *30 day notice of cancellation except in the event of nonpayment of premium 10 day notice of cancellation.
<br /> RE: Project No.21-6453 NE Annexation Water&Sewer Maint Improvements.The City of Santa Ana,its officers,officials,employees and volunteers are named
<br /> as Additional Insured regarding the General Liability policy per form CG 20 10 12 19 and CG 20 37 12 19 and the Auto policy per form MCA20480711.Insurance
<br /> is primary regarding the General Liability policy per form CG 20 01 12 19 and the Auto policy per form MCA CABE 08 23.Waiver of Subrogation applies
<br /> regarding the General Liability policy per form CG 24 04 12 19,the Auto policy per form MCA04440913,and the Workers Compensation policy per form WC 04
<br /> 0306.
<br /> SEE ATTACHED ACORD 101
<br /> APPROVED
<br /> CERTIFICATE HOLDER CANCELLATION By Tu Tran Nguyen at 4:50 pm,Apr23,2026
<br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> The City of Santa Ana THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br /> Y ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> Risk Management Division 4th Floor
<br /> 20 Civic Center Plaza
<br /> Santa Ana, CA 92701 AUTHORIZED REPRESENTATIVE
<br /> ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved.
<br /> The ACORD name and logo are registered marks of ACORD
<br />
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