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GLADGOV-01 LADDANKI
<br /> ,d►coRo CERTIFICATE OF LIABILITY INSURANCE F
<br /> DATE(MM/DD/YYYY)
<br /> 11/3/2025
<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 Cynthia Mullins
<br /> NAME:
<br /> HUB International Insurance Services Inc. PHONE FAX
<br /> 9855 Scranton Rd (A/C,No,Ext):(877) 825-2681 No):(951)231-2572
<br /> San Diego,CA 92121 E-MAIL-ADDRESS:Cal-CPU@Hubinternational.com
<br /> INSURERS AFFORDING COVERAGE NAIC#
<br /> INSURERA:Hartford Underwriters Insurance Company 30104
<br /> INSURED INSURERB:Hartford Accident and Indemnity Company 22357
<br /> Gladwell Governmental Services,Inc. INSURERC:Hartford Casualty Insurance Company 29424
<br /> P.O. Box 62 INSURER D:United States Liability Insurance 25895
<br /> Lake Arrowhead,CA 92352
<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 $ 2,000,000
<br /> CLAIMS-MADE X OCCUR 72SBABF4UK2 10/31/2025 10/31/2026 DAMAGE TO RENTED 1,000,000
<br /> 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� PEA LOC PRODUCTS-COMP/OP AGG $ 4,000,000
<br /> OTHER: $
<br /> B AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000
<br /> Ea accident $
<br /> X ANY AUTO X X 72UECPT0490 10/31/2025 10/31/2026 BODILY INJURY Perperson) $
<br /> OWNED SCHEDULED
<br /> AUTOS ONLY AUTOS BODILY INJURY Per accident $
<br /> HIRED NON-OWNED PROPERTY DAMAGE
<br /> AUTOS ONLY AUTOS ONLY Per accident)
<br /> ccident $
<br /> UMBRELLA LIAB OCCUR EACH OCCURRENCE $
<br /> EXCESS LIAB CLAIMS-MADE AGGREGATE $
<br /> DED RETENTION$ $
<br /> C WORKERS COMPENSATION X PER OTH-
<br /> AND EMPLOYERS'LIABILITY STATUTE ER
<br /> 72WECBK4F2G 10/31/2025 10/31/2026 1,000,000
<br /> ANY PROPRIETOR/EXCLUDED?
<br /> R/EXECUTIVE ❑ X E.L.EACH ACCIDENT $
<br /> OF EXCLUDED? N/A
<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 /> D Professional Liab. SP 10209550 10/31/20,25 10/31/2026 [Aggregate
<br /> er Claim/Occurrence 1,000,000
<br /> D Deductible:$2,500 SP 10209550 10/31/2025 10/31/2026 2,000,000
<br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
<br /> Revised 03/11/2025-This certificate rescinds and supersedes any and all prior certificates issued on behalf of the Named Insured.
<br /> City of Santa Ana,officers,agents,employees,and volunteers are Additional Insured with regard to General Liability when required by written contract per
<br /> the
<br /> attached endorsement form SL3032 06/21&SL303610/18.Additional Insured applies with regard to the Auto Liability policy,when required by written
<br /> contract,per the attached endorsement form HA991612/21,Waiver of Subrogation included.Waiver of Subrogation applies to the Workers Compensation
<br /> policy,when required by written contract,per the attached endorsement form WC040306.
<br /> CERTIFICATE HOLDER APPROVED CANCELLATION
<br /> By Tu Tran Nguyen at 8:53 am,Nov 03,2025
<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 ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> Tu Tran Ng�Y Tan
<br /> Attention:City Clerk by T.llytigned
<br /> 20 Civic Center Plaza, M-30 r
<br /> Santa Ana,CA 92701 Nguyen Date:2025.11.03 AUTHORIZED REPRESENTATIVE
<br /> 08:55:41-08'00'
<br /> ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved.
<br /> The ACORD name and logo are registered marks of ACORD
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