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78/5/2025
<br /> E(MM/DD/YYYY)
<br /> A�" CERTIFICATE OF LIABILITY INSURANCE
<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
<br /> NAME: Francisco Honzura
<br /> Arthur J. Gallagher Risk Management Services, LLC PHONE FAX
<br /> 4201 Westown Parkway, Suite 120 A/C No Ext: 515-309-6220 A/c,No:
<br /> E-MWest Des Moines IA 50266 ADDRESS: Francisco_Honzura@ajg.com
<br /> INSURER(S)AFFORDING COVERAGE NAIC#
<br /> INSURERA: Sentry Insurance Company 24988
<br /> INSURED MUSCLIG-01 INSURERB: Indian Harbor Insurance Company 36940
<br /> Musco Sports Lighting, LLC INSURERC:Travelers Property Casualty Company of America 25674
<br /> 100 1 st Ave W
<br /> Oskaloosa, IA 52577 INSURERD:
<br /> INSURER E:
<br /> INSURER F:
<br /> COVERAGES CERTIFICATE NUMBER:1003185892 REVISION NUMBER:
<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 TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS
<br /> LTR INSD WVD POLICY NUMBER MM/DD MM/DD
<br /> A X COMMERCIAL GENERALLIABILRY Y Y 9016877004 7/1/2025 7/1/2026 EACH OCCURRENCE $1,000,000
<br /> CLAIMS-MADE � OCCUR PREMISES DAMAGE TO
<br /> PREMISES Ea occurrence)
<br /> ccurrence $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 /> X POLICY� PRO- � LOC PRODUCTS-COMP/OP AGG $2,000,000
<br /> OTHER: $
<br /> A AUTOMOBILE LIABILITY Y Y 9016877003 7/1/2025 7/1/2026 COMBINED SINGLE LIMIT $1,000,000
<br /> Ea accident
<br /> X ANY AUTO BODILY INJURY(Per person) $
<br /> OWNED SCHEDULED BODILY INJURY(Per accident) $
<br /> AUTOS ONLY AUTOS
<br /> X HIRED X NON-OWNED FIR ERTYDAMAGE $
<br /> AUTOS ONLY AUTOS ONLY Per accident
<br /> C X UMBRELLALIAB X OCCUR CUP9X03061125NF 7/1/2025 7/1/2026 EACH OCCURRENCE $10,000,000
<br /> EXCESS LAB CLAIMS-MADE AGGREGATE $10,000,000
<br /> DED X RETENTION$1 n nnn $
<br /> A WORKERS COMPENSATION Y 9016877001 7/1/2025 7/1/2026 X PER OTH-
<br /> A AND EMPLOYERS'LIABILITY Y/N 9016877002 7/1/2025 7/1/2026 STATUTE ER
<br /> ANYPROPRIETOR/PARTNER/EXECUTIVE N/A E.L.EACH ACCIDENT $1,000,000
<br /> OFFICE R/M EMBER 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 /> B Architects&Engineers CE0742113905 7/1/2025 7/1/2026 Each Claim $5,000,000
<br /> Professional Liability& Aggregate $5,000,000
<br /> Pollution Liability Retention $250,000
<br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
<br /> RE: Blanket PO
<br /> City of Santa Ana, City Council,officers,officials,employees,agents and volunteers are shown as Additional Insured solely with respect to General Liability
<br /> coverage as evidenced herein on a Primary/Non-Contributory basis and Auto Liability as required by written contract with respect to work performed by the
<br /> Named Insured. A Waiver of Subrogation is included in favor of Additional Insured under the General Liability,Auto Liability and Workers Compensation
<br /> coverages as evidenced herein as required by written contract.
<br /> Digitally signed
<br /> Tu Tran uy Nguyenn [By
<br /> PPROVED
<br /> Ng
<br /> Nguyen Date:2025.08.22
<br /> 08:44:08-m'00' Tu Tran Nguyen at 8:43 am,Aug 22,2025
<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 /> PWA Parks Maintenance Division
<br /> 20 Civic Center Plaza AUTHORIZED REPRESENTATIVE
<br /> Santa Ana CA 92701
<br /> ©1988-2015 ACORD CORPORATION. All rights reserved.
<br /> ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD
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