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ADAMSTR-01 MCCOWANA
<br /> ,d►coRo CERTIFICATE OF LIABILITY INSURANCE DATE 1
<br /> 5/16/216/2025
<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#OE67768 CONTACT Lea Coleman
<br /> NAME:
<br /> IOA Insurance Services PHONE FAX
<br /> 3636 Nobel Drive (A/C,No,Ext):(619)400-1996 (A/C,No):
<br /> Suite 410 E-MAIL-ADDRESS:lea.coleman@ioausa.com
<br /> San Diego,CA 92122
<br /> INSURERS AFFORDING COVERAGE NAIC#
<br /> INSURERA:RLI Insurance Company 13056
<br /> INSURED INSURER B:Beazley America Insurance Company, Inc. 16510
<br /> Adams Streeter Civil Engineers,Inc. INSURER 7
<br /> 11711 Coley River Circle,Unit INSURERD:
<br /> Fountain Valley,CA 92708
<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 Xrl
<br /> OCCUR PSB0001237 9/1/2024 9/1/2025 DAMAGE TO RENTED 1,000,000
<br /> X X PREMISES Ea occurrence $
<br /> X Cont Liab/Sev of Int MED EXP(Any oneperson) $ 10,000
<br /> PERSONAL&ADV INJURY $ 1,000,000
<br /> GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000
<br /> X POLICY�X PEI° LOC PRODUCTS-COMP/OP AGG $ 2,000,000
<br /> OTHER: Ded $ 0
<br /> A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000
<br /> Ea accident $
<br /> X ANY AUTO X X PSA0001063 9/1/2024 9/1/2025 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 /> X Comp.:$500 X Coll.:$500
<br /> A UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 3,000,000
<br /> X EXCESS LIAB CLAIMS-MADE PSE0001201 9/1/2024 9/1/2025 AGGREGATE $ 3,000,000
<br /> DED X RETENTION$ 0 $
<br /> A WORKERS COMPENSATION X PER OTH-
<br /> AND EMPLOYERS'LIABILITY STATUTE ER
<br /> PSW0001554 9/1/2024 9/1/2025 1,000,000
<br /> ANY PROPRIETOR/ R/EXECUTIVE ❑ X E.L.EACH ACCIDENT $
<br /> EXCLU
<br /> OFFICER/MEMBER 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 /> B Professional Liab. X C21EE9250801 2/13/2025 2/13/2026 Per Claim 2,000,000
<br /> B Ded.:$40k Per Claim X C21EE9250801 2/13/2025 2/13/2026 Aggregate 4,000,000
<br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached if more space is required)
<br /> Re: Project Number: A-2021-085;PO 6925,Project Name:Agreement To Provide On-Call Development Plan Checking Services For Water Resources Division
<br /> City of Santa Ana,its officers,employees,agents and representatives are Additional Insureds with respect to General and Auto Liability per the attached
<br /> endorsements as required by written contract.Insurance is Primary and Non-Contributory.Waiver of Subrogation applies to General Liability,Auto Liability
<br /> and Workers'Compensation and PRofessional Liability.Officers excluded but they do not go onto the job sites. TU Tran Tran Nguyen
<br /> yr�
<br /> Tran Nguyen
<br /> Date:2025.05.1
<br /> 30 Days Notice of Cancellation with 10 Days Notice for Non-Payment of Premium in accordance with the policy provisions. Nguyen 08:46:26-07'00'
<br /> APPROVED
<br /> CERTIFICATE HOLDER CANCELLATION ByTu Tran Nguyen at8:45 am,May 16,2025
<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 AUTHORIZED REPRESENTATIVE
<br /> Attention: Public Works Agency,Water Resources Division —T—
<br /> 215 S.Center Street(M-85) oh �0W
<br /> Santa Ana CA 92701
<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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