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STETENG-01
<br />RBUCK
<br />ACORO CERTIFICATE OF LIABILITY INSURANCE
<br />DATE7/1/2 D/YYYY)
<br />7/1 /2024
<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 # OD01900
<br />GDI Insurance Agency, Inc.
<br />801 Geer Road
<br />Turlock, CA 95380
<br />CONTACT Rhonda Buck
<br />NAME:
<br />PHONE FAX
<br />(A/C, No, Ext): (888) 420-1967 1 (A/C, No):
<br />ADDRESS: Rhonda.Buck@gdiins.com
<br />INSURERS AFFORDING COVERAGE
<br />NAIC #
<br />INSURER A: The Ha 1A
<br />INSURED ie
<br />Ang
<br />INSURER B : The Hal l wer Xige'r1ic"an
<br />sura a om an
<br />3 0 4
<br />INSURERC: U.S..S /_CI fttsvied&
<br />29599
<br />Stetson Engineers, Inc.
<br />INSURER D :
<br />2171 E. Francisco Blvd, Ste. K
<br />San Rafael, CA 94901
<br />INSURER E : �a t
<br />• .
<br />irm iAnirAd�%_
<br />. . .A
<br />SURER F :
<br />COVERAGES CE I R. I ISION NUMBER:
<br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN SSUED 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/YYYY
<br />POLICY EXP
<br />MM/DD/YYY
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />CLAIMS -MADE X OCCUR
<br />X
<br />X
<br />OZFD955322
<br />7/1/2024
<br />7/1/2025
<br />DAMAGE TO RENTED
<br />PREMISES Ea occurrence
<br />300,000
<br />$
<br />X
<br />MED EXP (Any oneperson)
<br />$ 10,000
<br />see other cov
<br />PERSONAL & ADV INJURY
<br />$ 1,000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />GENERAL AGGREGATE
<br />$ 2,000,000
<br />POLICY X PE� LOC
<br />PRODUCTS - COMP/OP AGG
<br />$ 2,000,000
<br />$
<br />OTHER:
<br />A
<br />AUTOMOBILE
<br />LIABILITY
<br />COMBINED SINGLE LIMIT
<br />Ea accident
<br />1,000,000
<br />$
<br />X
<br />BODILY INJURY Perperson)
<br />$
<br />ANY AUTO
<br />X
<br />X
<br />AWFD955306
<br />7/1/2024
<br />7/1/2025
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />BODILY INJURY Per accident
<br />$
<br />X
<br />PROPERTY DAMAGE
<br />Per accident)
<br />ccident
<br />$
<br />HIRED X NON -OWNED
<br />AUTOS ONLY AUTOS ONLY
<br />A
<br />UMBRELLA LAB
<br />X
<br />OCCUR
<br />EACH OCCURRENCE
<br />$ 3,000,000
<br />X
<br />AGGREGATE
<br />$ 3,000,000
<br />EXCESS LAB
<br />CLAIMS -MADE
<br />OZFD955322
<br />7/1/2024
<br />7/1/2025
<br />DED X RETENTION $ 0
<br />$
<br />B
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY
<br />ANY PROPRIETOR/PARTNER/EXECUTIVE El
<br />OFFICER/MEMBER EXCLUDED?
<br />(Mandatory in NH)
<br />N / A
<br />WZFD928932
<br />7/1/2024
<br />7/1/2025
<br />X PER OTH-
<br />ISTATUTE I I ER
<br />E.L. EACH ACCIDENT
<br />1,000,000
<br />$
<br />E.L. DISEASE - EA EMPLOYEE
<br />1,000,000
<br />$ 1,000,000
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE - POLICY LIMIT
<br />1,000,000
<br />$
<br />C
<br />Professional Liab
<br />US2434831
<br />7/1/2024
<br />7/1/2025
<br />see remarks
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
<br />SEE ATTACHED ADDENDUM. 30 day notice of cancellation except 10 days when for nonpayment of premium. RE: N-2021-097
<br />Certificate Holder Note: City of Santa Ana its officers, employees, agents and representatives are
<br />additional insured with primary coverage and waiver of subrogation as
<br />required by written contract with respect to operations of the named
<br />insured perform 3911006, 4610478, BP0497, 4610478 & 4610155 attached.
<br />Waiver of subrogation per attached WC040306.
<br />CERTIFICATE HOLDER
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES RE CANCELLED BEFORE
<br />City of Santa Ana THE EXPIRATION DATE THEREOI
<br />y ACCORDANCE WITH THE POLICY PRC RA Mwagmient DiAsion
<br />Risk Mgmt Division E
<br />20 Civic Center Plaza 4th Fir
<br />REVIEWED&RPPROVEDBY:
<br />Santa Ana, CA 92701 AUTHORIZED REPRESENTATIVE A Ac"44
<br />ip r,> ® Risk Management Specialist
<br />ACORD 25 (2016/03) © 1988-2015 ACORD
<br />The ACORD name and logo are registered marks of ACORD
<br />
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