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KIMCSTA-01 MMCALLISTER
<br /> ,dâ–ºcoRo CERTIFICATE OF LIABILITY INSURANCE D 1TE 1/18/20YYYY)
<br /> 1/18/ 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#OM70471 CONTACT
<br /> NAME:
<br /> Orion Risk Management Insurance Services,An Alera Group Insurance PHONE FAX
<br /> Agency, LLC (A/C,No,Ext): (949)263-8850 No):(949)263-8860
<br /> 18575 Jamboree Rd,Suite 500 A DD E-MAIL
<br /> Irvine,CA 92612
<br /> INSURERS AFFORDING COVERAGE NAIC#
<br /> INSURERA:PHILADELPHIA INDEMNITY INSURANCE COMPANIES* 18058
<br /> INSURED INSURERB:XL Insurance America Inc 24554
<br /> Kimco Staffing Services,Inc. INSURER 7
<br /> 17872 Cowan Ave INSURER D:
<br /> Irvine,CA 92614
<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 $ 1,000,000
<br /> CLAIMS-MADE X OCCUR PHPK2599195007 9/1/2025 9/1/2026 rl DAMAGE TO RENTED 100,000
<br /> X X PREMISES Ea occurrence $
<br /> MED EXP(Any oneperson) $ 10,000
<br /> PERSONAL&ADV INJURY $ 1,000,000
<br /> GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 3,000,000
<br /> X POLICY PRO LOC PRODUCTS-COMP/OP AGG $ 3,000,000
<br /> OTHER: SEXUAL PHYSICAL $ 1,000,000
<br /> A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000
<br /> Ea accident $
<br /> X ANY AUTO X X PHPK2599195007 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 /> UMBRELLA LIAB OCCUR EACH OCCURRENCE $
<br /> EXCESS LIAB CLAIMS-MADE AGGREGATE $
<br /> DED RETENTION$ $
<br /> B WORKERS COMPENSATION X PER
<br /> AND EMPLOYERS'LIABILITY STATUTE EERR
<br /> RWD300121608 12/31/2024 12/31/2025 1,000,000
<br /> ANY PROPRIETOR/EXCLUDED?
<br /> R/EXECUTIVE N/A X E.L.EACH ACCIDENT $
<br /> OF EXCLUDED? LyJ(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 PHPK2599195007 9/1/2025 9/1/2026 Each Claim 1,000,000
<br /> A Professional Liabili PHPK2599195007 9/1/2025 9/1/2026 Aggregate 2,000,000
<br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
<br /> City of Santa Ana,its City Council,officers,officials,employees,agents,and volunteers are listed as additional insured with respects to General Liability and
<br /> Auto Liability per the terms of the attached endorsements.
<br /> Waiver of Subrogation applies per the terms of the attached General Liability,Auto Liability,Workers Compensation,and Professional Liability endorsements.
<br /> Tu Tran Digitally signed by
<br /> Tu Tran Nguyen
<br /> Date:2025.11.20 APPROVED
<br /> Nguyen 09:51:22-08,00'
<br /> By Tu Tran Nguyen at 9:50 am, Nov 20,2025
<br /> CERTIFICATE HOLDER CANCELLATION
<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 ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> Attention: Human Resources
<br /> 20 Civic Center Plaza
<br /> Santa Ana,CA 92701 AUTHORIZED REPRESENTATIVE
<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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