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710/9/2025
<br /> E(MM/DD/YYYY)
<br /> A�" CERTIFICATE OF LIABILITY INSURANCE
<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
<br /> NAME: Certificate Team
<br /> Inszone Insurance Services, LLC PHONE FAX
<br /> 2721 Citrus Road, Suite A A/C No Ext: 877-308-9663 A/c,No):916-400-2625
<br /> E-MRancho Cordova, CA 95742 ADDRESS: certs@inszoneins.com
<br /> INSURER(S)AFFORDING COVERAGE NAIC#
<br /> License#:OF82764 INSURERA: General Insurance Company of America 24732
<br /> INSURED INTEINC-15 INSURERB: Insurance Company of the West 27847
<br /> Inter-Pacific, Inc.
<br /> 39 Peters Canyon Road INsuRERc:West American Insurance Company 44393
<br /> Irvine, CA 92606 INSURERD:
<br /> INSURER E
<br /> INSURER F:
<br /> COVERAGES CERTIFICATE NUMBER:1878422685 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 LIMITS
<br /> LTR INSD WVD POLICYNUMBER MM/DD MM/DD
<br /> C X COMMERCIAL GENERAL LIABILITY Y Y BKW62698905 9/8/2025 9/8/2026 EACH OCCURRENCE $1,000,000
<br /> DAMAGES( RENTED
<br /> CLAIMS-MADE OCCUR
<br /> PREMISES Ea occurrence)
<br /> ccurrence) $500,000
<br /> MED EXP(Any one person) $15,000
<br /> PERSONAL&ADV INJURY $1,000,000
<br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000
<br /> POLICY❑ PRO ❑
<br /> JECT LOC PRODUCTS-COMP/OP AGG $2,000,000
<br /> X
<br /> OTHER: $
<br /> A AUTOMOBILE LIABILITY Y Y AZG62698905 9/8/2025 9/8/2026 COMBINED SINGLE LIMIT $1,000,000
<br /> Ea accident
<br /> X ANY AUTO BODILY INJURY(Per person) $
<br /> OWNED SCHEDULED BODILY INJURY(Per accident) $
<br /> AUTOS ONLY AUTOS
<br /> X HIRED X NON-OWNED PROPERTY DAMAGE $
<br /> AUTOS ONLY AUTOS ONLY Per accident
<br /> UMBRELLA LAB OCCUR EACH OCCURRENCE $
<br /> EXCESS LAB CLAIMS-MADE AGGREGATE $
<br /> DED RETENTION$ $
<br /> B WORKERS COMPENSATION Y WSA 5084780 00 6/9/2025 6/9/2026 X PER OTH-
<br /> AND EMPLOYERS'LIABILITY Y/N STATUTE ER
<br /> ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $1,000,000
<br /> OFFICER/MEMBER EXCLUDED? ❑ N/A
<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 /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached if more space is required)
<br /> RE:All CA Operations performed by the Named Insured.
<br /> The City of Santa Ana, its officers,officials,employees and volunteers are included as Additional Insured,with Primary/Non-Contributory and Waiver of
<br /> Subrogation,as respects to General Liability and Auto Liability, per Forms CG 88 10 04 13, CG 85 83 04 13 and AC 00 33 10 21.Waiver of Subrogation applies
<br /> to Workers'Compensation per form WC 99 06 34 When required by Written Contact. Digicauysigned
<br /> Tu Tran byrurran
<br /> Nguyen
<br /> Nguyen Da 355o1-0P00z APPROVED
<br /> CERTIFICATE HOLDER CANCELLATION i By Tu Tran Nguyen at 2:35 pm,Oct 22,2025
<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 ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> Attn: Heidi Chou
<br /> 215 S. Center St., M-85 AUTHORIZED REPRESENTATIVE
<br /> Santa Ana, CA 92701 `
<br /> @ 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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