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A`"R" CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY)
<br /> 02/04/2025
<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 CONTACT Shelby Cecena AFIS
<br /> NAME:
<br /> James G Parker Insurance Assoc AICNN. Ext: (559)584-3323 /X No: (559)584-9313
<br /> License#0554959 E-MAIL shelbyc@jgparker.com
<br /> ADDRESS:
<br /> P O Box 1129 INSURER(S)AFFORDING COVERAGE NAIC#
<br /> Hanford CA 93232 INSURERA: Landmark American Ins Co 33138
<br /> INSURED INSURER B: National Specialty Insurance Co 22608
<br /> Baker Rescue Services Inc INSURER C: State Compensation Ins Fund 35076
<br /> 19744 Beach Blvd#366 INSURER D:
<br /> INSURER E:
<br /> Huntington Beach CA 92648-2988 INSURERF:
<br /> COVERAGES CERTIFICATE NUMBER: 24-25 Master GL/BAIWC/ REVISION NUMBER:
<br /> THIS IS TO CERTIFYTHAT 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 MAYBE 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 UBR POLICY NUMBER MM/DD YYYYMPOLICY EFF O DD YYYY LIMITS
<br /> ICY EXP
<br /> LTR INSD WVD
<br /> X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
<br /> DAMAGE_7CLAIMS-MADE �OCCUR PREM SESOEa occu«Dence $ 50,000
<br /> MED EXP(Any one person) $ 5,000
<br /> A Y Y LHC860014 08/03/2024 08/03/2025 PERSONAL&ADV INJURY $ 1,000,000
<br /> GEN'LAGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $ 2,000,000
<br /> POLICY ❑ PRO ❑ 2,000,000
<br /> JECT LOC PRODUCTS-COMP/OPAGG $
<br /> OTHER: CGL&Professional Liab $ 2,000,000
<br /> AUTOMOBILE LIABILITY EC�h861i4ED6INGLE LIMIT $ 1,000,000
<br /> Ea accident
<br /> ANYAUTO BODILY INJURY(Per person) $
<br /> B OWNED �/ SCHEDULED Y Y GM1060601 08/03/2024 08/03/2025 BODILY INJURY(Per accident) $
<br /> AUTOS ONLY /� AUTOS
<br /> HIRED NON-OWNED PROPERTY DAMAGE $
<br /> AUTOS ONLY AUTOS ONLY Per accident
<br /> Uninsured motorist $ 1,000,000
<br /> UMBRELLA LIAB OCCUR EAC V`"H OCCURRENCE $ 5,000,000
<br /> A EXCESS LIAB CLAIMS-MADE LHA602060 08/03/2024 08/03/2025 AGGREGATE $ 5,000,000
<br /> DED I I RETENTION$ $
<br /> WORKERS COMPENSATION X STATUTE EORH
<br /> AND EMPLOYERS'LIABILITY Y/N 1,000,000
<br /> ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $
<br /> C OFFICER/MEMBER EXCLUDED? NIA Y 1851446-2024 09/01/2024 09/01/2025
<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 /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
<br /> City of Santa Ana,its City Council,its officers,officials,employees,agents,and volunteers are included as Additional Insured with respects to General
<br /> Liability per attached form RSG95001 0903 and Automobile Liability per attached form CA2048 1013.Primary&Non-contributory is included with respects to
<br /> General Liability per attached form RSG54155 0816.Wavier of Subrogation Applies with respects to General liability,Automobile liability and Workers
<br /> Compensation per attached forms RSG54078 0310,CA0444 1013&10217 REV.4-2018.
<br /> APPROVED
<br /> By Tu Tran Nguyen at 11:08 am,Feb 04,2025
<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 /> ATTN:Water Resources
<br /> 215 S.Center St 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 Tu Tran Digitally signed by Tu
<br /> Tran Nguyen
<br /> Nguyen 111094-08'004 1
<br />
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