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DATE(MM/DD/YYYY) <br /> A` "� CERTIFICATE OF LIABILITY INSURANCE 8/20/2024 <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 CN A O MENTACT <br /> : C AI,d <br /> TIB Transportation Insur ce Brokers, LLC • PHONE �F <br /> by: <br /> 425 W. Broadway, Suit 0 A/c No Ex. : 818 24 - c 6 6 <br /> Glendale CA 91204-1 ADDRESS: eha@acris om <br /> 2 <br /> ng ie <br /> SURER(S)AFr@ORDING C VERAGE NAIC# <br /> icense#:OK07568 INSURERA: , iS U ncJ4';;anAcPvea C) 22225 <br /> INSURED COACMAX-01 INSURER B Trl.'Ira Specia nsurance Company 16188 <br /> Coach Max Corp. <br /> DBA: Transportation Acevedc <br /> INSURER ,: Lloy Lon n <br /> 500 N. Ford Blvd. INSURF.D: ? 0? 1AR5. <br /> East Los Angeles CA Su'_,e e: <br /> Jr JRER F: <br /> COVERAGES CEATE NUMBER:18121287 4 S O MWEk kJ <br /> THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOV/ H'.✓E 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 TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS <br /> LTR I POLICY NUMBER MM/DD/YYYY MM/DDIYYYY <br /> A X COMMERCIAL GENERAL LIABILITY Y Y KGA015942401 8/24/2024 8/24/2025 EACH OCCURRENCE $1,000,000 <br /> CLAIMS-MADE OCCUR DAMAGE TO RENTED <br /> PREMISES Ea occurrence $100,000 <br /> MED EXP(Any one person) $5,000 <br /> PERSONAL&ADV INJURY $1,000,000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $1,000,000 <br /> POLICY PRO LOC PRODUCTS-COMP/OP AGG $1,000,000 <br /> X JECT <br /> OTHER:El $ <br /> A AUTOMOBILE LIABILITY Y Y KAA015942401 8/24/2024 8/24/2025 COMBINED SINGLE LIMIT $1,000,000 <br /> Ea accident <br /> ANY AUTO BODILY INJURY(Per person) $ <br /> OWNED X SCHEDULED BODILY INJURY(Per accident) $ <br /> AUTOS ONLY AUTOS <br /> X HIRED X NON-OWNED PROPERTY DAMAGE $ <br /> AUTOS ONLY AUTOS ONLY Per accident <br /> B UMBRELLALIAB X OCCUR Y KXA015942401 8/24/2024 8/24/2025 EACH OCCURRENCE $4,000,000 <br /> X EXCESS LIAB CLAIMS-MADE AGGREGATE $ <br /> DED RETENTION$ $ <br /> WORKERS COMPENSATION PER OTH- <br /> AND EMPLOYERS'LIABILITY YIN STATUTE ER <br /> ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ <br /> ❑ <br /> OFFICER/MEMBER EXCLUDED? NIA <br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ <br /> If yes,describe under <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ <br /> C Sexual Abuse and Molestation B0621 PCOAC000824 7/26/2024 7/26/2025 $1,000,000 $10,000 Deductible <br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) <br /> "Excess Liability Limit:$4,000,000 Over Auto Liability and General Liability. <br /> City of Santa Ana,its City Council,its officers,officials,employees,agents and volunteers are included as Additional Insured with respects to their interest in <br /> the operations of the named insured.Waiver of subrogation applies.Coverage is primary and non-contributory. <br /> CERTIFICATE HOLDER CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> THE EXPIRATION DATE THEREOF- NOTICF WILL FIF DELIVERED IN <br /> City of Santa Ana ACCORDANCE WITH THE POLICY PRC <br /> Attn: Risk Management Division a�.° "F RU Mmagement DiMskrn <br /> 20 Civic Center Plaza AUTHORIZED REPRESENTATIVE REVIEWED&APPROVED BY. <br /> Santa Ana CA 92702 4g;e Aecv44 <br /> _- ® Risk Management Specialist <br /> @ 1988-2015 ACORD <br /> ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD <br />