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<br /> HOWRGEN-01 DORTI
<br /> CERTIFICATE OF LIABILITY INSURANCE DATE YYYY)
<br /> 419/20 II2028
<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 endorsements.
<br /> PRODUCER AME•CT
<br /> f MG Skinner&Associates ',yHcNN,Ext; 310 478-5041 Fn c,No: 310 479-8707
<br /> 1666 20th St Ste 200
<br /> Santa Monica,CA 90404-3827
<br /> INSURERS AFFORDING COVERAGE NAIC#
<br /> jINSURER A:Underwriters at Lloyds London 15792
<br /> I INSURED INSURER B:Columbia Casualty/Compan jgNIA 31127
<br /> AppleOne,Inc,dba AppleOne Employment Services INSURER C:Ace American Ins Co 122667
<br /> fka:Howroyd Wright Employment Agency,Inc.
<br /> P.O.Box 29048 INSURER D:Axis Surplus Ins Co 26620
<br /> Glendale,CA 91209-9048 INSURER E
<br /> INSURER IF
<br /> I 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 /> IN8R ADDL SUER POLICY EFF POLICY EXP
<br /> j TYPE OP INSURANCE. N D POLICY NUMBER DD M DD LIMITS
<br /> I
<br /> A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 5,000,000
<br /> CLAIMS-MADE ®OCCUR X X PS00040761674 411/2026 4/1/2027 _ffiFkDAMAGE TO R occurrence $ 250,000
<br /> X Contractual 5,000
<br /> MED EXP(Any oneperson) $
<br /> I PERSONAL&ADV INJURY $ 5,000,000
<br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 5,000,000
<br /> X POLICY JCT �LOC PRODUCTS-COMPIOPAGG 5,000,DOD
<br /> OTHER:
<br />? A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT c 1,000,000
<br /> Es acfdenll_.
<br />{ X ANYAUTO PS00040761674 4/112026 4/112027 BODILY INJUR�Per person)$
<br /> E OWNED SCHEDULED "-
<br /> AUTOS ONLY NAUUpTNNOSyyryry EE BO�DILY INJURY Per accident $
<br /> k X AUTOS ONLY X AUTA30NNERTY
<br /> LY Pe�. ld.nt AMAGE $
<br /> f $
<br /> B X UMBRELLA LIAB VI OCCUR EACH OCCURRENCE $ 10,000,000
<br /> EXCESS LIAS CLAIMS-MADE 843739591 4/112026 41112027 AGGREGATE $ 10,000,000
<br /> DED X FRETENTION$ 0
<br /> C WORKERS COMPENSATION X STATUTE ERH
<br /> AND EMPLOYERS'LIABILITY
<br /> ANYPROPRIETOWI-ARTNEPJFXECUTIVE YIN WLRC72807960 4/112026 41112027 E.L.EACNAccIDENT 1,000,000
<br /> OpFICER�M M EXCLUDED? Y N/A
<br /> {INandatoryrn 1,000,000
<br /> i� E.L.DISEASE-EA EMPLOYEE
<br /> I Irrs,describe tinder
<br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1,000,000
<br /> D Crime(3rd party) P-001-001920357-01 41112026 41112027 OccurroncelAggregate 3,000,OOD
<br /> A Prof.LIab1E&0 PS00040761674 411/2026 4/112027 OccurroncolAggregate 5,000,000
<br /> DESCRIPTION OF OPERATIONS 1 LOCATIONS!VEHICLES (ACORD 101,Addlilonal Remarks Schedule,may be attached If more space Is required)
<br /> Job ID 009500724003
<br /> Re-,City of Santa Ana Agreement No.A 2018446.The City of Santa Ana,officers,agents,employees and volunteers are named additional insured on this
<br /> policy pursuant to written contract,agreement,or memorandum of understanding. Primary and Nan-Contribulory coverage will apply.Waiver of Subrogation
<br /> Is covered under General Liability for clerical positions only. Notice of Cancellation under applicable policies:30 days110 days for non-payment of premium.
<br /> APPROVED
<br /> CERTIFICATE HOLDER CANCELLATION By Tu Tran Nguyen at 2:49 pm,Apr 30,2026
<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 /> ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> Attn:Jay Jenkins
<br /> 20 Civic Center Plaza
<br /> Santa Ana,CA 92701-4010 AUTHORIZED REPRESENTATIVE
<br /> ACORD 25(2016103) O 1988-2015 ACORD CORPORATION. All rights reserved.
<br /> The ACORD name and logo are registered marks of ACORD
<br />
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