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Client#: 2100128 FCSINT
<br /> DATE(MM/DD/YYYY)
<br /> ACORDT1,1 CERTIFICATE OF LIABILITY INSURANCE 1 4/29/2026
<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 LaFonda Smith
<br /> NAME:
<br /> USI Insurance Services, LLC PHONE 713 490-4600 FAX 713-490-4700
<br /> A/C,No,Ext: (A/C,No):
<br /> 9811 Katy Freeway, Suite 500 ADDRESS: LaFonda.Smith@usi.com
<br /> Houston, TX 77024 INSURER(S)AFFORDING COVERAGE NAIC#
<br /> 713 490-4600
<br /> INSURER A:Nautilus Insurance Company 17370
<br /> INSURED INSURER B:Great Divide Insurance Company 25224
<br /> FCS International, Inc
<br /> INSURER C:Beazley Excess and Surplus Lines Ins 17520
<br /> 250 Commerce Suite 210 INSURERD:Houston Casualty Company 42374
<br /> Irvine, CA 92602 INSURER E: MSIG Special Insurance USA,Inc. 34886
<br /> Specialty
<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 /> ADDLSUBR
<br /> LTR TYPE OF INSURANCE NSR WVD POLICY NUMBER POLICY EFF POLICY EXP LIMITS
<br /> (MM/DD/YYYY) (MM/DD/YYYY)
<br /> A X COMMERCIAL GENERAL LIABILITY ECP204889610 01/01/2026 01/01/2027 EACH OCCURRENCE $1,000,000
<br /> CLAIMS-MADE L*OCCUR PREMISESOEa oceu ante $100,000
<br /> X BI/PD Ded:10000 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 /> E AUTOMOBILE LIABILITY HN0100099400 1/01/2026 01/01/202 EOaacccioeD SINGLELIMIT $1,000,000
<br /> ANY AUTO BODILY INJURY(Per person) $
<br /> OWNED SCHEDULED BODILY INJURY(Per accident) $
<br /> AUTOS ONLY AUTOS
<br /> HIRED NON-OWNED PROPERTY DAMAGE
<br /> X AUTOS ONLY X AUTOS ONLY Per accident $
<br /> XDeductible 5,000 $
<br /> A UMBRELLA LIAB OCCUR FFX204889710 1/01/2026 01/01/2027 EACH OCCURRENCE $5000000
<br /> X EXCESS LIAB X CLAIMS-MADE AGGREGATE $5 000 000
<br /> DED RETENTION$ $
<br /> B WORKERS COMPENSATION WCA204889510 01/01/2026 01/01/2027 X STER
<br /> ATUTE EORH
<br /> AND EMPLOYERS'LIABILITY
<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$1,000,000
<br /> C Cyber Liab D316F7260501 1/01/2026 01/01/202 $2M Agg/$5k ded
<br /> D Prof Liab HCC2626391 1/01/2026 01/01/202 $2M ea claim/$4M agg
<br /> $100k ded ea claim
<br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
<br /> The General Liability and Auto policy includes an automatic Additional Insured endorsement that provides
<br /> Additional Insured status to the Certificate Holder only when there is a written contract that requires such
<br /> status, and only with regard to work performed by or on behalf of the named insured, including completed
<br /> operations if required by contract. The General Liability and Auto Liability policy(s) provide a Blanket
<br /> Waiver of Subrogation when required by written contract, except as prohibited by law. The General Liability
<br /> (See Attached Descriptions) APPROVED
<br /> CERTIFICATE HOLDER CANCELLATION By Tu Tran Nguyen at 12:17 pm,May 01,2026
<br /> City f Santa Ana SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> y o THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br /> Risk Management Division ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> 20 Civic Center Plaza
<br /> Santa Ana, CA 92702 AUTHORIZED REPRESENTATIVE
<br /> ©1988-2015 ACORD CORPORATION.All rights reserved.
<br /> ACORD 25(2016/03) 1 of 2 The ACORD name and logo are registered marks of ACORD
<br /> #S53942327/M52755784 GXHZZ
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