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/ 1 ®'`� CERTIFICATE OF LIABILITY IN`i � DATE(MMIDD/YYYY)
<br /> y S�g �� 1/24/2024
<br /> THIS CERTIFICATE IS ISSUED AS A MATTER OF INFOR I N ONFERS 'JQ RIGI-f'S UPON THE CERTIFICATE HOLDER. THIS
<br /> CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIV M D H
<br /> OR AL 'E 1I3E AFFORDED BY THE POLICIES
<br /> BELOW. THIS CERTIFICATE OF INSURANCE DOES N I A ONTRAC' lETVVEEN Acevedo
<br /> INSURER(S), AUTHORIZED
<br /> REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
<br /> IMPORTANT: If the certificate holder is an ADDITIONAL!NI R ).. �fITIoNie�LI'�il��U i 8 •ro ons or be endorsed.
<br /> If SUBROGATION IS WAIVED, subject to the terms and c• .i ns i c to r WrZ4 .e..: nt. A statement on
<br /> this certificate does not confer rights to the certificate hol•er i u e r e CONT1, )(] i�
<br /> PRODUCER Lockton Insurance Brokers,LLC NAME: ', 1 5:29:3 1 -08'OO'
<br /> NAME:
<br /> 777 S.Figueroa Street,52nd Fl. PHON.i Fax
<br /> CA License#OF15767 E-MAILo Ext): (A/C,No):
<br /> Los Angeles CA 90017 ADDRESS:
<br /> (213)689-0065 INSURER(S)AFFORDING COVERAGE NAIC#
<br /> INSURER A:Crum&Forster Specialty Insurance Co 44520
<br /> INSURED Rincon Consultants,Inc. INSURER B:Hartford Fire Insurance Company 19682
<br /> 1462718 180 N Ashwood Ave. INSURER C:Crum and Forster Insurance Company 42471 _
<br /> Ventura CA 93003 INSURER D:Palomar Excess and Surplus Insurance Co. 16754
<br /> INSURER E:Starstone National Insurance Company 25496
<br /> INSURER F:
<br /> COVERAGES RINCO01 CERTIFICATE NUMBER: 16059509 REVISION NUMBER: XX� {XX
<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 LTR TYPE OF INSURANCE ADDL
<br /> W D POLICY NUMBER BR POLICY EFF POLICY EXP LIMITS
<br /> J (MMIDD/YYYY) (MMIDD/YYYY)
<br /> A X COMMERCIAL GENERAL LIABILITY Y Y EPK-142587 2/1/2023 2/1/2025 EACH OCCURRENCE • $ 3,000,000
<br /> DAMAGE RENTED
<br /> CLAIMS-MADE X OCCUR PREMISESO(Ea occurrence) ,$ 100,000
<br /> X SIR:$50,000 MED EXP(Any one person) $ 10,000
<br /> X P&I PERSONAL&ADV INJURY :$ 3,000,000
<br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 4,000,000
<br /> POLICY X JECT LOC PRODUCTS-COMP/OP AGG $ 4,000,000
<br /> OTHER: $
<br /> B AUTOMOBILE LIABILITY y y 72UENOL5481 2/1/2024 2/1/2025 COMBINED NGLE LIMIT $
<br /> (Ea accident)SI 1,000,000
<br /> X ANY AUTO BODILY INJURY(Per person) $ XXXXXXX
<br /> OWNED SCHEDULED BODILY INJURY(Peridt
<br /> AUTOS ONLY AUTOS accident) $ XXXXXXX
<br /> X AUTOS ONLY HIRED X AUTOS ONLY (Per PROPERTY
<br /> ))DAMAGE $ XXXXXXX
<br /> Como./Coll.Ded $ 1,000
<br /> C UMBRELLALIAB X OCCUR N N EFX-119720 2/1/2024 2/1/2025 EACH OCCURRENCE _$ 10,000,000
<br /> D X EXCESS LIAR CLAIMS-MADE EVEQ-0000005 2/1/2024 2/1/2025 AGGREGATE $ 10,000,000
<br /> DED X RETENTIONS 10,000 $ XXXXXXX
<br /> B WORKERS COMPENSATION Y PER OTH-
<br /> AND EMPLOYERS'LIABILITY Y/N T10220329 2/1/2024 2/1/2025 X STATUTE ER
<br /> ANY PROPRIETOR/PARTNER/EXECUTIVE N N/A E.L.EACH ACCIDENT $ 1,000,000
<br /> OFFICER/MEMBER EXCLUDED?
<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 $ 1,000,000
<br /> A Contractors Pollution Liab N N EPK-142587 2/1/2023 2/1/2075 Limit:$3,000,000/$4,000,000
<br /> E&O Liab. Limit:$3,000,000/$4,000,000
<br /> Retro Date: 12/9/1994
<br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required)
<br /> Effective 2/1/2024-8/l/2025,Cybcr Liability S5M Limit,$25k Retention,Carrier:HCC;Policy 4H24NGP224923-0l,$5M x$5M Limit,Carrier:Corvus,Policy#CXS-107946155-00.The City of
<br /> Santa Ana and Community Development Agency and their officers,employees,agents and volunteers are an Additional Insured to the extent provided by the policy language or endorsement issued or
<br /> approved by the insurance carrier.Waiver of Subrogation applies per attached endorsement(s)or policy language.Insurance provided to Additional Insured(s)is primary and non-contributory as per the
<br /> attached endorsement or policy language.Excess policy follows General Liability,Auto Liability and Employers Liability form.Notice of Cancellation applies per the applicable policy language or
<br /> endorsements.
<br /> CERTIFICATE HOLDER CANCELLATION See Attachments
<br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> 16059509 THE EXPIRATION DATE THEREOF. NOTICE WILL BE DELIVERED IN
<br /> City of Santa Ana ACCORDANCE WITH THE POLICY PRC\ /
<br /> o,ort,�s Risk MsmaganattD[vision
<br /> Risk Management Divison AUTHORIZED REPR z? REVIEWED&APPRt71!®8Y:
<br /> 20 Civic Center Plaza,4th Floor `• I' 1 t A,4,
<br /> Santa Ana CA 92701 / ;=align.
<br /> 1-----1� Risk Management Spedalist
<br /> ©1 88-201 C D/ Ss,
<br /> ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD
<br />
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