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Client#: 74070 BIDANYU
<br /> DATE(MM/DD/YYYY)
<br /> ACORD.,,, CERTIFICATE OF LIABILITY INSURANCE 1 3/07/2025
<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 any rights to the certificate holder in lieu of such endorsement(s).
<br /> PRODUCER CONTACT Rosanne Coyne
<br /> Assured Partners of Ohio, LLC PHONE 440 333-9000 FAX
<br /> A/C,No,Ext: (A/C,No):
<br /> 3900 Kinross Lakes Pkwy#300 ADDRESS: SBUProofs@,4ssuredPartnersOH.com
<br /> Richfield, OH 44286-9445 INSURER(S)AFFORDING COVERAGE NAIC#
<br /> 440 333-9000 INSURER A:United States Liability Insurance Co 25895
<br /> INSURED INSURER B:Hartford Fire Insurance Co 19682
<br /> Bi Dan Yu dba Young Rembrandts North
<br /> INSURER C
<br /> Orange County
<br /> INSURER D
<br /> 1060 N. Mar Vista Ave.
<br /> INSURER E
<br /> Pasadena, CA 91104
<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 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 /> INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS
<br /> LTR INSR WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY
<br /> A X COMMERCIAL GENERAL LIABILITY X X GL1190670B 03/07/2025 03/07/2026 EACH OCCURRENCE $1,000,000
<br /> CLAIMS-MADE L*OCCUR PREMISES(ERENTED
<br /> nte) $100,000
<br /> MED EXP(Any one person) $5,000
<br /> PERSONAL&ADV INJURY $1,000,000
<br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000
<br /> X POLICY JECOT LOC PRODUCTS-COMP/OP AGG $2,000,000
<br /> OTHER: $
<br /> A AUTOMOBILE LIABILITY X GL1190670B 3/07/2025 03/07/202 COMBINED Ea accidentS INGLE LIMIT 1e e 000 000
<br /> ANY AUTO BODILY INJURY(Per person) $
<br /> OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) $
<br /> HIRED NON-OWNED PROPERTY DAMAGE
<br /> X AUTOS ONLY X AUTOS ONLY Per accident $
<br /> A X UMBRELLA LIAB X OCCUR CUP1572191 B 3/07/2025 03/07/2026 EACH OCCURRENCE s2,0001000
<br /> EXCESS LIAB CLAIMS-MADE AGGREGATE s2,000,000
<br /> DED I I RETENTION$ 1 $
<br /> B WORKERS COMPENSATION X 45WECAW2FB9 03/07/2025 03/07/202 X PER OTH-
<br /> AND EMPLOYERS'LIABILITY STATUTE ER
<br /> Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $1,000,000
<br /> OFFICER/MEMBER EXCLUDED? [N] 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 Sexual Abuse/ X GL1190670B 03/07/2025 03/07/2026 $1,000,000/$2,000,000
<br /> Molestation
<br /> A I Professional Liab GL1190670B 03/07/2025 03/07/2026 $1,000,000/$2,000,000
<br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
<br /> The City of Santa Ana, its officers, officials,employees, and volunteers are to be covered as Digitallysigned
<br /> additional insureds on the CGL policy with respect to liability arising out of work or operations TU Tran byTuTran
<br /> Nguyen
<br /> performed by or on behalf of the Permittee including materials, parts, or equipment furnished in Nguyen Date:2025.03.24
<br /> connection with such work or operations.A Waiver of Subrogation is in favor of the City of Santa 11:38:51-07'00'
<br /> Ana for the General Liability,Auto and Sexual Abuse and Molestation and Worker's Compensation
<br /> policies. I
<br /> APPROVED
<br /> CERTIFICATE HOLDER CANCELLATION ByTu Tran Nguyen at 11:38 am,Mar24,2025
<br /> City Of Santa Ana Parks and SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br /> Recreation Dept. ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> 185 W. Civic Center Dr.
<br /> Santa Ana, CA 92703 AUTHORIZED REPRESENTATIVE
<br /> 11X �r1,..1�--
<br /> ©1988-2015 ACORD CORPORATION.All rights reserved.
<br /> ACORD 25(2016/03) 1 of 1 The ACORD name and logo are registered marks of ACORD
<br /> #S1090516/M1090496 EGOLT
<br />
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