|
Client#: 180949 CTCAMER
<br /> DATE(MM/DD/YYYY)
<br /> ACORDTM CERTIFICATE OF LIABILITY INSURANCE 1 8/20/2025
<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 any rights to the certificate holder in lieu of such endorsement(s).
<br /> PRODUCER CONTACT Commercial Support
<br /> Edgewood Partners Ins. Center PHONE 631-390-9700 FAX 631-390-9790
<br /> A/C,No,Ext: (A/C,No):
<br /> 40 Marcus Drive E-MAIL ADDRESS: NECertificates@epicbrokers.com
<br /> Icbrokers.com
<br /> (�
<br /> 3rd Floor INSURER(S)AFFORDING COVERAGE NAIC#
<br /> Melville, NY 11747 Palomar Excess and Surplus Insurance Co 16754
<br /> INSURER A: P
<br /> INSURED INSURER B:Twin City Fire Insurance Company 29459
<br /> LAD(Aviation), Inc. dba Charles Taylor
<br /> INSURER c:QBE Insurance Corporation 39217
<br /> Environmental Technical Services
<br /> 135 State College Blvd INSURER D:
<br /> Brea, CA 92821 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 CONTRACTOR 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 /> ADDLSUBR
<br /> LTR TYPE OF INSURANCE NSR WVD POLICY NUMBER POLICY EFF POLICY EXP LIMITS
<br /> (MM/DD/YYYY) (MM/DD/YYYY)
<br /> A X COMMERCIAL GENERAL LIABILITY Y Y ENC000915204 05/01/2025 05/01/2026 EACH OCCURRENCE $1,000,000
<br /> CLAIMS-MADE 4 OCCUR PREMI6ESOEa oNcurrDence $100,000
<br /> X BI/PD Ded:5,000 MED EXP(Any one person) $25,000
<br /> PERSONAL&ADV INJURY $1,000,000
<br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000
<br /> POLICY JECT X LOC
<br /> PRO-
<br /> PRODUCTS-COMP/OPAGG $2,000,000
<br /> OTHER: $
<br /> B AUTOMOBILE LIABILITY Y Y 12UENBH6B5K 05/01/2025 05/01/202 EeaBc,deDSINGLELIMIT $1,000,000
<br /> X ANY AUTO BODILY INJURY(Per person) $
<br /> OWNED SCHEDULED BODILY INJURY(Per accident) $
<br /> AUTOS ONLY AUTOS
<br /> HIRED NON-OWNED PROPERTY DAMAGE
<br /> X AUTOS ONLY X AUTOS ONLY Per accident $
<br /> A UMBRELLA LAB X OCCUR ENX000915304 05/01/2025 05/01/2026 EACH OCCURRENCE s5,000,000
<br /> X EXCESS LAB CLAIMS-MADE AGGREGATE s5,000,000
<br /> DED RETENTION$ $
<br /> B WORKERS COMPENSATION Y 12WEAR6ZCZ 05/01/2025 05/01/2026 X STATUTE EERH
<br /> AND EMPLOYERS'LIABILITY
<br /> Y/N ANY PROPRIETOR/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 /> C Professional Liab Y QPL3596780 05/01/2025 05/01/2026 $2,000,000 Per Clm/Agg
<br /> A Pollution Liab ENC000915204 05/01/2025 05/01/202 $1 M Per Occ/$2M Per Agg
<br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
<br /> The following are included as additional insureds on a primary and non-contributory basis for general Digitally signed y
<br /> liability and auto liability coverage as required by written contract. Tu Trdn Tu DatTran
<br /> e:te:2 Nguyen
<br /> 2025.08.2
<br /> City of Santa Ana, its City Council, officers,officials,employees,agents,and volunteers Nguyen 09:49:26-07'00'
<br /> A waiver of subrogation applies in favor of the additional insureds for general liability,auto liability,
<br /> workers compensation and professional liability as required by written contract.
<br /> iPMOVED
<br /> CERTIFICATE HOLDER CANCELLATION By Tu Tran Nguyen at 9 48 am,Aug 20, 5
<br /> City of Santa Ana,Attention: SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> y THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br /> Human Resources Department ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> 20 Civic Center Plaza
<br /> Santa Ana, CA 92701 AUTHORIZED REPRESENTATIVE
<br /> ©1988-2015 ACORD CORPORATION.All rights reserved.
<br /> ACORD 25(2016/03) 1 of 1 The ACORD name and logo are registered marks of ACORD
<br /> #S7874917/M7767849 TM006
<br />
|