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JLEEENG-01 YUENG
<br /> ,d►coRo CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DYYYY)
<br /> 9/9/20
<br /> 25
<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 License#OE67768 CONTACT Glgl Yuen
<br /> NAME:
<br /> IOA Insurance Services PHONE
<br /> 3875 Ho yard Road (A/C,No,Ext):(925) 660-3514 FAX No):(925)416-7869
<br /> E-MAIL Suite 20 ADDRESS:Gig I Yuen ioausa.com
<br /> Pleasanton,CA 94588
<br /> INSURERS AFFORDING COVERAGE NAIC#
<br /> INSURERA:RLI Insurance Company 13056
<br /> INSURED INSURERB:Arch Insurance Company 11150
<br /> JLee Engineering,Inc. INSURER 7
<br /> 430 S.Garfield Avenue,#301 INSURER D 7
<br /> Alhambra,CA 91801
<br /> INSURER E
<br /> INSURER F:
<br /> COVERAGES CERTIFICATE NUMBER: 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 NUMBER POLICY EFF POLICY EXP LIMITS
<br /> LTR INSD WVD MM/DD/YYYY MM/DD/YYYY
<br /> A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000
<br /> CLAIMS-MADE j OCCUR PSB0010319 9/1/2025 9/1/2026 DAM ES E a occAGE TO RENTED 1,000,000
<br /> PREMISurrence $
<br /> MED EXP(Any oneperson) $ 10,000
<br /> PERSONAL&ADV INJURY $ 2,000,000
<br /> GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 4,000,000
<br /> POLICY X71 PEA LOC PRODUCTS-COMP/OP AGG $ 4,000,000
<br /> OTHER: $
<br /> A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000
<br /> Ea accident $
<br /> ANY AUTO PSA0003335 9/1/2025 9/1/2026 BODILY INJURY Perperson) $
<br /> OWNED SCHEDULED
<br /> AUTOS ONLY AUTOS BODILY INJURY Per accident $
<br /> X HIRED X NON-OWNED PROPERTY DAMAGE
<br /> AUTOS ONLY AUTOS ONLY Per accident)
<br /> ccident $
<br /> UMBRELLA LIAB OCCUR EACH OCCURRENCE $
<br /> EXCESS LIAB CLAIMS-MADE AGGREGATE $
<br /> DED RETENTION$ $
<br /> A WORKERS COMPENSATION X PER
<br /> AND EMPLOYERS'LIABILITY STATUTE EERR
<br /> Y/N PSW0005581 9/1/2025 9/1/2026 1,000,000
<br /> ANY PROPRIETOR/EXCLUDED?
<br /> R/EXECUTIVE N/A E.L.EACH ACCIDENT $
<br /> OF EXCLUDED?
<br /> (Mandatory in NH) E.L.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 /> B Professional Liab. PAAEP0102507 9/1/2025 9/1/2026 Per Claim 2,000,000
<br /> B Professional Liab. PAAEP0102507 9/1/2025 9/1/2026 Aggregate 4,000,000
<br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
<br /> All Operations of the Named Insured.
<br /> General Liability:See Additional Insured Endorsement attached;such coverage is Primary&Non-Contributory with Separation of Insureds and Waiver of
<br /> Subrogation included,as required by written contract.
<br /> Auto Liability: ***Note that the Insured owns no company owned vehicles.*** Aforementioned Auto policy includes coverage for Hired&Non-Owned Auto
<br /> Liability only.
<br /> Workers'Compensation:Waiver of Subrogation is included as per attached Waiver of Subrogation Endorsement,as required by written contract.
<br /> Professional Liability includes Waiver of Subrogation,as required by written contract.
<br /> SEE ATTACHED ACORD 101
<br /> CERTIFICATE HOLDER APPROVED CANCELLATION
<br /> By Tu Tran Nguyen at 11:55 am,Sep 10,2025
<br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br /> ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> Digitally signed
<br /> TU Tran by Tu Tran
<br /> City of Santa Ana Nguyen AUTHORIZED REPRESENTATIVE
<br /> Planning and Building Agency Nguyen Date:2025.09.10 - /�
<br /> 20 Civic Center Plaza 1 1:56:12-07'00'
<br /> Santa Ana,CA 92701
<br /> ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved.
<br /> The ACORD name and logo are registered marks of ACORD
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