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711/25/2025
<br /> E(MM/DD/YYYY)
<br /> ACOR" CERTIFICATE OF LIABILITY INSURANCE
<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 CONTACT
<br /> NAME: Jessica Lund
<br /> The Baldwin Group West, LLC PHONE FAX
<br /> 15901 Red Hill Ave, Ste 100 vC No Ext: 714-824-8366 A/c,No):(714)573-1770
<br /> E-MTustin CA 92780 ADDRESS: jessica.lund@baldwin.com
<br /> INSURER(S)AFFORDING COVERAGE NAIC#
<br /> License#:OF69771 INSURERA: Everest Indemnity Insurance Co 10851
<br /> INSURED CARDENV-01 INSURERB: State Compensation Insurance F 35076
<br /> 5M Contracting Inc.
<br /> 2681 Dow Ave. Ste C1 INsuRERc: Everest National Insurance Com 10120
<br /> Tustin CA 92780 INSURERD:
<br /> INSURER E:
<br /> INSURER F:
<br /> COVERAGES CERTIFICATE NUMBER:495414129 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 EFF POLICY EXP LIMITS
<br /> LTR INSD WVD POLICYNUMBER MM/DD MM/DD
<br /> A X COMMERCIAL GENERAL LIABILITY Y Y EF4CE00134-251 1/1/2025 1/1/2026 EACH OCCURRENCE $2,000,000
<br /> DAMAGES( RENTED
<br /> CLAIMS-MADE OCCUR
<br /> PREMISES Ea occurrence)
<br /> ccurrence) $50,000
<br /> X BI/PD:$5,000 MED EXP(Any one person) $5,000
<br /> PERSONAL&ADV INJURY $2,000,000
<br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $3,000,000
<br /> PRO-
<br /> POLICY� ECT1:1 LOC PRODUCTS-COMP/OP AGG $3,000,000
<br /> OTHER: $
<br /> C AUTOMOBILE LIABILITY Y Y EF4CA00561-251 1/1/2025 1/1/2026 COMBINED SINGLE LIMIT $1,000,000
<br /> Ea accident
<br /> X ANY AUTO BODILY INJURY(Per person) $
<br /> OWNED SCHEDULED BODILY INJURY(Per accident) $
<br /> AUTOS ONLY AUTOS
<br /> X HIRED X NON-OWNED PROPERTY DAMAGE $
<br /> AUTOS ONLY AUTOS ONLY Per accident
<br /> A UMBRELLA LAB X OCCUR EF4XS00154-251 1/1/2025 1/1/2026 EACH OCCURRENCE $5,000,000
<br /> X EXCESS LAB CLAIMS-MADE AGGREGATE $5,000,000
<br /> DED RETENTION$ $
<br /> B WORKERS COMPENSATION Y 9330685-25 1/1/2025 1/1/2026 X PER OTH-
<br /> AND EMPLOYERS'LIABILITY Y/N STATUTE ER
<br /> ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $1,000,000
<br /> OFFICER/MEMBER EXCLUDED? FY] 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 /> A Contractor Pollution EF4CE00134-251 1/1/2025 1/1/2026 Limit/Deductible $10,000,000/$5,000
<br /> A Professional Liability EF4CE00134-251 1/1/2025 1/1/2026 Limit/Deductible $1,000,000/$5,000
<br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
<br /> A Waiver of Subrogation in favor of the City of Santa Ana, its City Council,officers,officials,employees,agents,and volunteers applies to General Liability,
<br /> Commercial Auto, Pollution, Professional Liability,and Workers Compensation if required by written contract,and subject to terms,conditions,and exclusions of
<br /> the policy.
<br /> Coverage is provided on a Primary& Non-Contributory basis on the General Liability, Pollution,and Professional Liability,if required by written contract and
<br /> subject to terms,conditions and exclusions of the policy.
<br /> City of Santa Ana, its City Council,officers,officials,employees,agents,and volunteers are included as an Additional Insured with respect to General Liability,
<br /> Commercial Auto, Pollution,and Professional Liability if required by written contract and subject to terms,conditions,and exclusions of the policy.
<br /> 30-day notice of cancellation,except for nonpayment of premium-in regard General Liability, Commercial Auto, Pollution,and Professional Liability policies
<br /> CERTIFICATE HOLDER APPROVED CANCELLATION
<br /> By Tu Tran Nguyen at 12:24 pm,Dec 09,2025
<br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br /> City of Santa Ana DigitsTranlly signed
<br /> ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> Y TU Tran by Tu Tran
<br /> 20 Civic Center Plaza Nguyen
<br /> Santa Ana CA 92701 NguyenDate:2025.12D9 AUTHORIZED REPRESENTATIVE
<br /> 12:24:52-08'00'
<br /> Y'
<br /> @ 1988-2015 ACORD CORPORATION. All rights reserved.
<br /> ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD
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