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_____........,40 JENSHUG-01 TWANG3
<br /> AC'ORO CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY)
<br /> `------ 5/29/2024
<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#0C36861 CONTACT
<br /> NAME:
<br /> Alliant Insurance Services,Inc.
<br /> 560 Mission St 6th Fl (APH/C,NoONE FAX
<br /> ,Ext):(41 )946-7500 (A/C,No):
<br /> Dig ita I lyA nec
<br /> San Francisco,CA 94105Angie .
<br /> INSURER(S)AFFORDING COVERAGE NAIL 1/
<br /> by An g i eNSURER A:Charter Oak Fire Insurance Company 25615
<br /> INSURED INSURER B:Travelers Property Casualty Company of America 25674
<br /> Jensen Hu hes Inc. Acevedo.. C:Starr Surplus Lines Insurance Company 13604
<br /> 3610 Co c(re �1e d o
<br /> Baltimor 12 V Date. 24 � 6.06
<br /> COVERAGES CERTiFIr ATE NUMBER��•23•TINsBfj:00� REVISION NUMBER:
<br /> THIS IS TO CERTIFY THAT THE POLIO CS JF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
<br /> INDICATED. NOTWITHSTANDING ANY I<tQUIREMENT, 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 TYPE OF INSURANCE ADOL SUER POLICY NUMBER POLICY EFF POLICY EXP LIMITS
<br /> LTRINSD WVp ((AMLDDPYYYY1 IMM/DD/YYYYI
<br /> A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
<br /> CLAIMS-MADE X OCCUR X X P-630-9W377045-00E-24 6/1/2024 6/1/2025 PREMISES((En occur ence) $ 1,000,000
<br /> MED EXP(Any one person) $ 10,000
<br /> PERSONAL&ADV INJURY $ 1,000,000
<br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000
<br /> POLICY X JECT LOC PRODUCTS-COMP/OP AGG $ 2,000,000
<br /> OTHER: $
<br /> B AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000
<br /> (Ea accident) $
<br /> X ANY AUTO BA-9R228458-24-43-G 6/1/2024 6/1/2025 BODILY INJURY(Per person) $
<br /> OWNED SCHEDULED
<br /> AUTOS ONLY AUTOS BODILY INJURY(Per accident) $
<br /> AUTOS ONLY NON-OWNEDO (Per PROPERTY
<br /> tDAMAGE $
<br /> $
<br /> B X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,000
<br /> EXCESS LIAB CLAIMS-MADE CUP-9R228956-24-43 6/1/2024 6/1/2025 AGGREGATE $ 1,000,000
<br /> DED RETENTION$ $
<br /> B WORKERS COMPENSATION
<br /> AND EMPLOYERS'LIABILITY X STATUTE OTH-
<br /> ER
<br /> Y/N UB-2Y365586-24-43-G 6/1/2024 611/2025 1,000,000
<br /> ANY PROPRIETOR/PARTNER/EXECUTIVE N N/A E.L.EACH ACCIDENT $
<br /> (Mandatory in NHR EXCLUDED? 1,000,000
<br /> ) E.L.DISEASE-EA EMPLOYEE $
<br /> If yes,describe under 1,000,000
<br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $
<br /> C Professional Liab. 1000600146241 6/18/2024 6/18/2025 Per Claim/Aggregate 2,000,000
<br /> DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
<br /> Expiring Professional Liability Policy
<br /> Insurer:Starr Surplus Lines Insurance Company
<br /> Policy Number:1000600146231
<br /> Policy Term:3/15/2023-6/18/2024
<br /> Re:City of Santa Ana ADA Self-Evaluation and Transition Plan JH Project#1JKI00100
<br /> The City,its officers,officials,employees,and volunteers are included as additional insured with respect to general liability on a primary and non-contributory
<br /> basis when required by written contract per the attached endorsement,including a waiver of subrogation.
<br /> CERTIFICATE HOLDER CANCELLATION
<br /> SHOULD ANY OF THE ABOVE DESCRIBEDB POLICIES BE CANCELLED BEFORE THE EXPTION DATE THEREOw
<br /> City of Santa Ana ACCORDANCE WITH THE POLICY PRC \ f
<br /> 20 Civic Center Plaza ,,,,!PL.,,<,, Risk
<br /> Santa Ana,CA 92701 a ` REVIEWED&APPROVEDBY:
<br /> AUTHORIZED REPRESENTATIVE °I,.Y110 7A4scia i`!Le!gki
<br /> 1"I Jn( • :L r
<br /> { .(,-,, ----- Risk Management Specialist
<br /> ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved.
<br /> The ACORD name and logo are registered marks of ACORD
<br />
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