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<br />DATE (MM/DD/YYYY)
<br />CERTIFICATE OF LIABILITY INSURANCE
<br />01/09/2025
<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 />CONTACT
<br />PRODUCER Christina DeWeese
<br />NAME:
<br />FAX
<br />PHONE
<br />Milt Brandt General Insurance(707) 433-4436(707) 433-6239
<br />(A/C, No):
<br />(A/C, No, Ext):
<br />E-MAIL
<br />250 Healdsburg Ave., 3rd Floorchristina@brandtinsurance.com
<br />ADDRESS:
<br />P.O. Box V
<br />INSURER(S) AFFORDING COVERAGENAIC #
<br />HealdsburgCA95448Fireman's Fund Insurance Company21873
<br />INSURER A :
<br />INSURED American Automobile Insurance Company21849
<br />INSURER B :
<br />E & M Electric & Machinery, Inc.Sentinel Insurance Company, LTD11000
<br />INSURER C :
<br />126 Mill StreetLloyd's of LondonAA1128623
<br />INSURER D :
<br />INSURER E :
<br />HealdsburgCA95448
<br />INSURER F :
<br />CL251213539
<br />COVERAGESCERTIFICATE 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 />ADDLSUBR
<br />INSRPOLICY EFFPOLICY EXP
<br />TYPE OF INSURANCELIMITS
<br />POLICY NUMBER
<br />LTR(MM/DD/YYYY)(MM/DD/YYYY)
<br />INSDWVD
<br />COMMERCIAL GENERAL LIABILITY 1,000,000
<br />EACH OCCURRENCE$
<br />DAMAGE TO RENTED
<br />100,000
<br />CLAIMS-MADEOCCUR$
<br />PREMISES (Ea occurrence)
<br />5,000
<br />MED EXP (Any one person)$
<br />AYUSC01334025001/01/202501/01/20261,000,000
<br />PERSONAL & ADV INJURY$
<br />2,000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER:GENERAL AGGREGATE$
<br />PRO-
<br />2,000,000
<br />POLICYLOCPRODUCTS - COMP/OP AGG$
<br />JECT
<br />$
<br />OTHER:
<br />COMBINED SINGLE LIMIT
<br />AUTOMOBILE LIABILITY 1,000,000
<br />$
<br />(Ea accident)
<br />ANY AUTOBODILY INJURY (Per person)$
<br />OWNEDSCHEDULED
<br />BYSCV011813250101/01/202501/01/2026
<br />BODILY INJURY (Per accident)$
<br />AUTOS ONLYAUTOS
<br />HIREDNON-OWNEDPROPERTY DAMAGE
<br />$
<br />(Per accident)
<br />AUTOS ONLYAUTOS ONLY
<br />Uninsured motorist1,000,000
<br />$
<br />combined single limit
<br />UMBRELLA LIAB
<br />OCCUREACH OCCURRENCE$
<br />EXCESS LIAB
<br />CLAIMS-MADEAGGREGATE$
<br />DEDRETENTION$$
<br />PEROTH-
<br />WORKERS COMPENSATION
<br />STATUTEER
<br />AND EMPLOYERS' LIABILITY
<br />Y / N
<br />1,000,000
<br />ANY PROPRIETOR/PARTNER/EXECUTIVE
<br />E.L. EACH ACCIDENT$
<br />CN N / A Y57WEBM3S9J12/31/202412/31/2025
<br />OFFICER/MEMBER EXCLUDED?
<br />1,000,000
<br />(Mandatory in NH)
<br />E.L. DISEASE - EA EMPLOYEE$
<br />If yes, describe under
<br />1,000,000
<br />DESCRIPTION OF OPERATIONS belowE.L. DISEASE - POLICY LIMIT$
<br />Each Annual$2,000,000
<br />Professional Liability (E&O) incl Cyber
<br />DB0621PEMEL00022406/01/202406/01/2025AggregateOccurrence$2,000,000
<br />Increased Limits Active 10/06/2020
<br />Deductible$25,000
<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 officers, employees, agents and representatives are named as Additional Insureds with respect to General Liability and Auto Liability
<br />per the attached endorsements CG 71 93 3 19 and CA 70 18 10 14. Insurance is Primary and Non-Contributory. Such insurance as is afforded by this
<br />policy shall be primary, and any insurance carried by City shall be excess and noncontributory per attached form CG 71 93 03 19 and CA 00 01 10 13.
<br />30 Day Notice of Cancellation with 10 Days Notice for Non-Payment of Premium in accordance with the policy provisions per attached form 145977 01 11 &
<br />145977 03 19.
<br />Waiver of subrogation applies to Workers' Compensation insurance per attached form WC 04 03 06.
<br />CzDzouijbNpsbbu:;28bn-Kbo26-3136
<br />CERTIFICATE HOLDERCANCELLATION
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />City of Santa Ana Risk Management Division
<br />20 Civic Center Plaza, 4th Fl
<br />AUTHORIZED REPRESENTATIVE
<br />Santa AnaCA92701
<br />© 1988-2015 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2016/03)The ACORD name and logo are registered marks of ACORD
<br />
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