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ACOR" CERTIFICATE OF LIABILITY INSURANCE
<br />6..�
<br />DATE(MM/DD/YYYY)
<br />1 4/17/2025
<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
<br />Burnham WGB Insurance Solutions
<br />CA Insurance License OF69771
<br />Red Hill Avenue
<br />CONTACT
<br />Carmen Cisneros
<br />PHONE FAX
<br />vC No EXt: 714-824-8388 (A/C, No:
<br />E-M15901
<br />ADDRESS: carmen.cisneros@wgbib.com
<br />INSURER(S) AFFORDING COVERAGE
<br />NAIC#
<br />Tustin CA 92780
<br />INSURERA: State Compensation Insurance F
<br />35076
<br />INSURED NATIO14
<br />National Safety Services, Inc.
<br />5562 Research Dr, Unit B
<br />INSURER B: Lloyd's of London
<br />15642
<br />INSURERC: United Financial Casualty Co
<br />11770
<br />INSURER D: Palms Insurance Company, Ltd
<br />Huntington Beach CA 92649
<br />INSURER E :
<br />INSURER F :
<br />COVERAGES CERTIFICATE NUMBER:771668961 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
<br />LTR
<br />TYPE OF INSURANCE
<br />ADDL
<br />INSD
<br />SUBR
<br />WVD
<br />POLICY NUMBER
<br />POLICY EFF
<br />MM/DD
<br />POLICY EXP
<br />MM/DD
<br />LIMITS
<br />B
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />Y
<br />Y
<br />CSIEL01883-00
<br />2/1/2025
<br />2/1/2026
<br />EACH OCCURRENCE
<br />$1,000,000
<br />CLAIMS -MADE OCCUR
<br />PREMISES DAMAGE TO
<br />PREMISES Ea occurrence)
<br />ccurrence
<br />$ 100,000
<br />MED EXP (Any one person)
<br />$ 10,000
<br />PERSONAL 8 ADV INJURY
<br />$ 1,000,000
<br />GEN'L
<br />AGGREGATE LIMIT APPLIES PER:
<br />GENERAL AGGREGATE
<br />$ 2,000,000
<br />POLICY � PECOT- LOC
<br />PRODUCTS - COMP/OP AGG
<br />$ 2,000,000
<br />X
<br />Pollution Liability
<br />$ 1,000,000
<br />OTHER: DED $5,000
<br />C
<br />AUTOMOBILE
<br />LIABILITY
<br />992664368
<br />2/4/2025
<br />8/4/2025
<br />COMBINED SINGLE LIMIT
<br />Ea accident
<br />$ 1,000,000
<br />BODILY INJURY (Per person)
<br />$
<br />ANY AUTO
<br />OWNED X SCHEDULED
<br />AUTOS ONLY AUTOS
<br />BODILY INJURY (Per accident)
<br />$
<br />X
<br />PROPERTY DAMAGE
<br />Per accident
<br />$
<br />HIRED NON -OWNED
<br />AUTOS ONLY AUTOS ONLY
<br />D
<br />UMBRELLA LAB
<br />X
<br />OCCUR
<br />CSIXEL00751-00
<br />2/1/2025
<br />2/1/2026
<br />EACH OCCURRENCE
<br />$5,000,000
<br />X
<br />AGGREGATE
<br />$ 5,000,000
<br />EXCESS LAB
<br />CLAIMS -MADE
<br />DED RETENTION $
<br />$
<br />A
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY Y / N
<br />ANYPROPRIETOR/PARTNER/EXECUTIVE
<br />91240802025
<br />2/4/2025
<br />2/4/2026
<br />X PER OTH-
<br />STATUTE ER
<br />E.L. EACH ACCIDENT
<br />$ 1,000,000
<br />OFFICE R/MEMBER EXCLUDED? ❑
<br />N/A
<br />E.L. DISEASE - EA EMPLOYEE
<br />$ 1,000,000
<br />(Mandatory in NH)
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE - POLICY LIMIT
<br />$ 1,000,000
<br />D
<br />Professional Liability
<br />CSIPMPL00253-00
<br />2/1/2025
<br />2/1/2026
<br />Each Claim Limit
<br />$1,000,000
<br />Aggregate Limit
<br />$2,000,000
<br />Deductible
<br />10,000
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required)
<br />City of Santa Ana, its City Council, officers, officials, employees, agents, and volunteers are included as Additional Insured with respect to General Liability if
<br />required by written contract and subject to terms, conditions and exclusions of the policy.
<br />Digitally signed APPROVED
<br />TLI Trait by Tu Trait
<br />Nguyen
<br />Nguyen 090840-0 oo$ By Tu Tran Nguyen at 9:08 am, Apr 18, 2025
<br />CERTIFICATE HOLDER CANCELLATION
<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 ACCORDANCE WITH THE POLICY PROVISIONS.
<br />Public Works Agency, Water Resources Division
<br />215 S. Center Street (M-85) AUTHORIZED REPRESENTATIVE
<br />Santa Ana CA 92703
<br />@ 1988-2015 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
<br />THIS CERTIFICATE SUPERSEDES PREVIOUSLY ISSUED CERTIFICATE
<br />
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