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FCSINTE-01 MCCOWANA <br />CERTIFICATE OF LIABILITY INSURANCE <br />D 12/22/2023 ) <br />12122/2023 <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 endorsements . <br />PRODUCER License # OE67768 <br />CA Insurance Services Digitally <br />3636 Nobel Drive <br />te� ! � Acevedo Aceved <br />1 91� Date: 20 <br />_ <br />CONTACT n <br />FAX <br />(All, No, Ext>: 6 - 0203 A/c, No :(619) 574-6288 <br />EMAIL . Dana.Schwartz@ioausa.com <br />RDINGCOVERAGE <br />NAICM <br />•: LII r e m an <br />13056 <br />INSURED-071001 <br />FCS International, Inc. <br />250 Commerce, Suite 250 <br />Irvine, CA 92602 <br />INSURER B: Hudson Insurance Company <br />25054 <br />INSURER C: <br />INSURER D <br />INSURER E : <br />NSURERF: <br />COVFRAGFS CFRTIFICATF NIIMRFR- RolltetOM ANIanRRR. <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 />TYPE OF INSURANCE <br />ADOL <br />SUBR <br />POLICY NUMBER <br />POLICY EFF <br />POLICY UPLTR <br />LIMITS <br />A <br />X <br />COMMERCIAL GENERAL LIABILITY <br />CLAIMS -MADE OCCUR <br />Cont Liab/Sev of Int <br />X <br />X <br />PSB0008629 <br />1N/2024 <br />1/1/2025 <br />EACH OCCURRENCE <br />1,000,000 <br />DAMAGEEWED <br />EMISES TO <br />1,000,000 <br />X <br />MED UP (My one arson <br />10,000 <br />PERSONAL& ADV INJURY <br />11000,000 <br />AGGREGATE LIMIT APPLIES PER: <br />POLICY JEE LOC <br />GENERALAGGREGATE <br />$ 2,000,000 <br />GEN'L <br />PRODUCTS. COMP/OP AGG <br />2,000,000 <br />I Ded <br />0 <br />OTHER: <br />A <br />AUTOMOBILE <br />LIABILITY <br />,0MBINEDSINGLE LIMIT <br />acciden <br />1000+000 <br />BODILYIWURY Per arson <br />ANY AUTO <br />OWNED SCHEDULED <br />AUTOS ONLY AUUT�OpSW <br />X <br />PSA0002832 <br />1N/2024 <br />1/1/2025 <br />BODILYINJURY Peraccitlenl <br />X <br />AUTOS ONLY X AUTOS ONLB <br />ANuobs.Owned <br />PerOaccka,AMAGE <br />X <br />A <br />UMBRELLA LIAB <br />X <br />OCCUR <br />EACH OCCURRENCE <br />$ 5,000,000 <br />AGGREGATE <br />5,000,000 <br />X <br />EXCESS LIAB <br />CLAIMS -MADE <br />PSE0004283 <br />1/1/2024 <br />111/2025 <br />DEO X RETENTION$ 0 <br />A <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY <br />ANY PROPRIETORIPARTNER/EXECUTIVE YIN <br />Wg�e ER/MEMBWR EXCLUDED? <br />(mandatory in NH) <br />If yes, describe undo' <br />DESCRIPTION OF OPERATIONS below <br />NIA <br />X <br />PSW0004799 <br />1/112024 <br />1/1/2025 <br />X PER OTH- <br />TA TE E <br />E. L. EACH ACCIDENT <br />1,000,000 <br />E.L. DISEASE - EA EMPLOYEE <br />$ 1,000,000 <br />E.L. DISEASE - POLICY LIMIT <br />1,000,000 <br />B <br />Professional Liab. <br />PRB0619117942 <br />1/1/2024 <br />111 22025 <br />Per Claim <br />2,000,000 <br />B <br />Professional Liabili <br />PRB0619117942 <br />111/2024 <br />1/1/2025 <br />Aggregate <br />2,000,000 <br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) <br />Re: COSA <br />City of Santa Ana is Additional Insureds with respect to General and Auto Liability per the attached endorsements as required by written contract. Insurance <br />is Primary and Non -Contributory. Waiver of Subrogation applies to General Liability and Workers' Compensation. <br />30 Days Notice of Cancellation with 10 Days Notice for Non -Payment of Premium in accordance with the policy provisions. <br />City of Santa Ana <br />Risk Management Division <br />20 Civic Center Plaza <br />ACORD 25 (2016/03) <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREO <br />ACCORDANCE WITH THE POLICY PR( <br />Risk <br />AUTHORIZED REPRESENTATIVE <br />V 8[ I11-W <br />Management Dlvie[art <br />REVIEWED lY APPROVRJ BY: <br />A+.�:r Adw4�a <br />® <br />Risk Management Specialist <br />©1988-2015 ACORD CORPORATION. All rights reserved. <br />The ACORD name and logo are registered marks of ACORD <br />