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CWE0000-01 KSITYAMALA
<br /> ,d►coRo CERTIFICATE OF LIABILITY INSURANCE F
<br /> DATE(MM/DD/YYYY)
<br /> 11/6/2025
<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 rights to the certificate holder in lieu of such endorsement(s).
<br /> PRODUCER License#0757776 CONTACT Donna Jones
<br /> NAME:
<br /> HUB International Insurance Services Inc. PHONE FAX
<br /> 600 Corporate Pointe Suite 600 (A/C,No,Ext): (A/C,No):
<br /> Culver City,CA 90230 E-MAIL-ADDRESS:donna.jones@hubinternational.com
<br /> INSURERS AFFORDING COVERAGE NAIC#
<br /> INSURER A:Crum&Forster Specialty Insurance Company 44520
<br /> INSURED INSURER B:National Fire& Marine 20079
<br /> CWE INSURERC:Pacific Compensation Insurance Company 11555
<br /> 1561 E.Orangethorpe Avenue
<br /> Suite 240 INSURER 7
<br /> Fullerton,CA 92831 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 X OCCUR EPK-149909 12/8/2024 12/8/2025 DAMAGE TO RENTED 100 000
<br /> X X PREMISES Ea occurrence $
<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 X 71 PEA LOC PRODUCTS-COMP/OP AGG $ 4,000,000
<br /> OTHER: POLLUTION LIABI $ 2,000,000
<br /> B AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000
<br /> Ea accident $
<br /> ANY AUTO X 72APBO11724 6/6/2025 6/6/2026 BODILY INJURY Perperson) $
<br /> OWNED SCHEDULED
<br /> AUTOS ONLY X AUTOS BODILY INJURY Per accident $
<br /> X HIRED X NON-OWNED PROPERTY DAMAGE
<br /> AUTOS ONLY AUTOS ONLY Per accident)
<br /> ccident $
<br /> A UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,000
<br /> X EXCESS LIAB CLAIMS-MADE EFX-126836 12/8/2024 12/8/2025 AGGREGATE $ 1,000,000
<br /> DED RETENTION$ $
<br /> C WORKERS COMPENSATION X PER OTH-
<br /> AND EMPLOYERS'LIABILITY X STATUTE ER
<br /> 1025483 12/1/2024 12/1/2025 1,000,000
<br /> ANY PROPRIETOR/ R/EXECUTIVE N/A E.L.EACH ACCIDENT $
<br /> EXCLU
<br /> OFFICER/MEMBER 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 /> A Professional Liabili X EPK-149909 12/8/2024 12/8/2025 Each Wrongful Act 2,000,000
<br /> A Professional Liabili X EPK-149909 12/8/2024 12/8/2025 Aggregate 4,000,000
<br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
<br /> Re: Project Name:A-2023-088-08 Santa Ana On-Call Engineering Services.
<br /> Revised 11-06-2025 This certificate rescinds and supersedes any and all prior certificates issued on behalf of the Named Insured.
<br /> The City of Santa Ana,20 Civic Center Plaza,Santa Ana,California 92701;officers,agents,employees,representatives and volunteers are Additional Insured
<br /> with regard to General Liability when required by written contract per the attached endorsement forms#EN0111 02/11 and#EN0147 11/11.Primary&Non-
<br /> Contributory wording applies with regard to General Liability when required by written contract per the attached endorsement form#EN0147 11/11.Waiver of
<br /> Subrogation with regard to General Liability applies when required by written contract per the attached endorsement form#EN0147 11/11.Per Project
<br /> SEE ATTACHED ACORD 101
<br /> CERTIFICATE HOLDER APPROVED CANCELLATION
<br /> By Tu Tran Nguyen at 10:25 am,Nov 12,2025
<br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> City of Santa Ana THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br /> Y Digitallysigned ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> Attn:Public Works Agency TU Tran byTuTran
<br /> CIP/Design Engineering Nguyen
<br /> 20 Civic Center Plaza, M-36 Nguyen Date:2025.11.12 AUTHORIZED REPRESENTATIVE
<br /> Santa Ana,CA 92701 10:26:30-08'00' �
<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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