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DATE(MM/DD/YYYY)
<br /> A�" CERTIFICATE OF LIABILITY INSURANCE 6/18/2025
<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
<br /> NAME: Telisa Gibson
<br /> RBN Insurance Services PHONE FAX
<br /> 303 E Wacker Dr Ste 650 A/C No Ext: 312-856-9400 A/c,No:312-856-9425
<br /> Chicago IL 60601 ADDE-MRESS: tgibson@rbninsurance.com
<br /> INSURER(S)AFFORDING COVERAGE NAIC#
<br /> INSURERA: Underwriters at Lloyds 15792
<br /> INSURED ESOURCE-01 INSURERB: Hartford Insurance Group
<br /> E Source Companies LLC
<br /> Utiliworks INsuRERc: Hartford Fire Insurance Co. 19682
<br /> 3020 Carbon Place, Suite 300 INSURERD:Trumbull Insurance Company 27120
<br /> Boulder CO 83301 INSURER E: Hartford Casualty Insurance Co 29424
<br /> INSURER F:
<br /> COVERAGES CERTIFICATE NUMBER:538100529 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 POLICYNUMBER MM/DD MM/DD
<br /> C X COMMERCIAL GENERAL LIABILITY Y Y 83UUNBM5WV\Ml 6/14/2025 6/14/2026 EACH OCCURRENCE $1,000,000
<br /> CLAIMS-MADE OCCUR DAMAGE TO RENTED
<br /> PREMISES Ea occurrence $300,000
<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❑ PRO ❑
<br /> JECT LOC PRODUCTS-COMP/OP AGG $2,000,000
<br /> X
<br /> OTHER: $
<br /> D AUTOMOBILE LIABILITY Y 83UENBG3L2R 6/14/2025 6/14/2026 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 PROPERTY DAMAGE $
<br /> AUTOS ONLY AUTOS ONLY Per accident
<br /> E X UMBRELLA LAB X OCCUR 83RHUBP3ZPX 6/14/2025 6/14/2026 EACH OCCURRENCE $5,000,000
<br /> EXCESS LAB CLAIMS-MADE AGGREGATE $5,000,000
<br /> DED RETENTION$ $
<br /> B WORKERS COMPENSATION Y 83VVEBG3L3G 6/14/2025 6/14/2026 X PER OTH-
<br /> AND EMPLOYERS'LIABILITY Y/N STATUTE ER
<br /> ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $1,000,000
<br /> OFFICER/MEMBER EXCLUDED? FN] N/A
<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 Technology/Professional Liability APT1237925 6/14/2025 6/14/2026 Each Claim/Aggregate 5000000 each
<br /> C Crime 10 KB 0778860-25 6/14/2025 6/14/2026 Limit 1,000,000
<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,officers,officials,employees,agents,and volunteers are listed as additional insured on primary and non-contributory basis
<br /> with respect to the General Liability as required by written contract or agreement.Waiver of Subrogation applies in favor of additional insured with respect to the
<br /> General Liability and Workers Compensation as required by written contract or agreement.30 Days' Notice of Cancellation applies. Umbrella Liability follows
<br /> the GL.Auto Liability and Workers Comp. Tu I Can TuTralnyNguyenby
<br /> T
<br /> Nguyen 0073448-0700'9 APPROVED
<br /> CERTIFICATE HOLDER CANCELLATION By Tu Tran Nguyen at 7:34 am,Jun 19,2025
<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 /> Attention: Public Works Agency
<br /> 215 S Center St AUTHORIZED REPRESENTATIVE
<br /> Santa Ana CA 92703 7
<br /> @ 1988-2015 ACORD CORPORATION. All rights reserved.
<br /> ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD
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