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EVERLEVELI
<br />JEANA
<br />ilk. O CERTIFICATE OF LIABILITY INSURANCE
<br />`�
<br />DATE D/YYYY)
<br />1/4/2023
<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(ki s) 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 endorsements .
<br />PRODUCER
<br />CONTACT
<br />NAME:
<br />(ac°Nri , Est): 949 553-9800 C. No):(949 553-0670
<br />The Wooditch Company Insurance Services, Inc.
<br />1 Park Plaza, Suite 400
<br />AE DRESS:
<br />Irvine, CA 92614
<br />INSURERS AFFORDING COVERAGE
<br />NAIL#
<br />INSURER A: Westchester Fire Ins. Co.
<br />10030
<br />INSURED
<br />INSURER B: Infinity Select Insurance Company
<br />20260
<br />INSURER C: Everest Premier Insurance Company
<br />16045
<br />Everl-evel Holdings, LLC
<br />INSURER D:
<br />5877 Pine Ave., Ste. 240
<br />Chino Hills, CA 91709
<br />INSURER E
<br />INSURER F
<br />COVERAGES CERTIFICATE NUMBER: REVISION NIIMRFR.
<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 DOCUMENTWITH 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
<br />TYPE OF INSURANCE
<br />ADDL
<br />SUBR
<br />POLICY NUMBER
<br />POLICY EFF
<br />MIDDYEXP
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE X OCCUR
<br />X
<br />G72507137 002
<br />21412022
<br />21412023
<br />EACH OCCURRENCE
<br />If 1,000,000
<br />DAMAGE TO RENTED
<br />PREMISES fEa occurrence
<br />100,000
<br />GEN-L
<br />X
<br />MEG FXP (Anyone emon
<br />5,000
<br />PERSONAL a ADV INJURY
<br />1,000,000
<br />AGGREGATE LIMIT APPLIES PER:
<br />POLICY�5pa LOC
<br />OTHER: Deductible: $5,000
<br />GENERAL AGGREGATE
<br />2,000,000
<br />PRODUCTS - COMP/OP AGG
<br />2,000,000
<br />EMPLAGGREGATE
<br />S 1,000,000
<br />13
<br />AUTOMOBILE
<br />X
<br />LIABILITY
<br />ANY AUTO
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />HIRED NON -OWN
<br />AUTOS ONLY AUTOS ONLY
<br />504-61016-7439-001
<br />1/1/2023
<br />1/112024
<br />COMBINED SINGLE LIMIT
<br />1,000,000
<br />BODILY INJURY Per arson
<br />$
<br />BODILY INJURY Peraccid.,A
<br />$
<br />PeROPPE�RtlTY DAMAGE
<br />$
<br />UMBRELLA LIAR
<br />EXCESS LIAR
<br />OCCUR
<br />CLAIMS -MADE
<br />EACH OCCURRENCE
<br />$
<br />Id
<br />AGGREGATE
<br />DED I I RETENTION$
<br />C
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY YIN N
<br />ANYPROPRIETOR/PARTNEWEXECUTIVE ❑
<br />I��FI5ERIMEMBER EXCLUDED?
<br />(Mantlstory in NH)
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />NIA
<br />7600022073231
<br />1/1/2023
<br />111/2024
<br />TH-
<br />X STATUTE OER
<br />E.L. EACH ACCIDENT
<br />$ 1,000,000
<br />E.L. DISEASE - FA EMPLOYE
<br />11000,000
<br />E.L. DISEASE - POLICY LIMIT
<br />1,000,000
<br />$
<br />DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES ACORD 101, Additional Remarks Schedule, may he attached if more space is required)
<br />2-1341; RE: City of Santa Ana Job #21st Street lope Stabilization. glaip/aup
<br />The City of Santa Ana, its officers, employees, agents, volunteers and representatives are included as Additional Insureds as respects General Liability per
<br />attached endorsement.
<br />This insurance shall apply as Primary and Non -Contributory per attached endorsement.
<br />CERTIFICATE HOLDER CANCELLATION
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />of Ana
<br />CitySanta
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />Risk Management Division, 4th Floor
<br />20 Civic Center Plaza
<br />AUTHORIZED REPRESENTATIVE
<br />Santa Ana, CA 92701
<br />ACORD 25 (2016103) ©1988-2015 ACORD CORPORATION. All rights reserved.
<br />The ACORD name and logo are registered marks of ACORD
<br />
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