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ACoRD® CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYY()
<br /> 8/23/2024
<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 CONTACT
<br /> NAME: charisls Ferqu I •
<br /> GMGS Risk Manag ent& Insurance services PHONE — I cne�J(,,� by
<br /> 6201 Oak Can oe (NC.No'ILa t)
<br /> Irvine, CA 92618 A DRESS: - C e m s.co
<br /> NSURER S)AFFORDIN OVERAGE NAIL#
<br /> www.gmgs.com g1j
<br /> INSURER A CI l�Ur f, C�v e d o 20338
<br /> INSURED INSURER : L'ndmark A rican Insurance Company 33138
<br /> Legion Contractors, Inc. INSURE C: St. tion I �ju p 35076
<br /> 445 S. Figueroa Str t, Suite 2580 m • O• �85202
<br /> Los Angeles CA 9 1 \I'
<br /> INSUF.R D: Cr W. I• S
<br /> OINS'nER E
<br /> _LIr SURER F: •
<br /> COVERAGES CERTIFICATE NUMBER: 815667FJ 1 6•42.R6/1610N DA EROV
<br /> THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW ;,AVE 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 ADDL SUBR POLICY EFF POLICY EXP
<br /> LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER ,MM/DD/YYYY) (MM/DD/YYYYL LIMITS
<br /> A / COMMERCIAL GENERAL LIABILITY CPGLP-00000114 5/12/2024 5/12/2025 EACH OCCURRENCE $1,000,000
<br /> DAMAGE TO RENTED
<br /> CLAIMS-MADE ✓ OCCUR PREMISES(Ea occurrence) $50,000
<br /> MED EXP(Any one person) $Excluded
<br /> PERSONAL&ADV INJURY $1,000,000
<br /> GEN'L AGGREGATE LIMIT APPLIESPER: GENERAL AGGREGATE $2,000,000
<br /> POLICY ✓ JECT LOC PRODUCTS-COMP/OP AGG $2,000,000
<br /> OTHER: s
<br /> A AUTOMOBILE LIABILITY CPBAP-00000115 5/12/2024 5/12/2025 COMBINED SINGLE LIMIT $
<br /> (Ea accident) 1,000,000
<br /> ,/ ANY AUTO BODILY INJURY(Per person) $
<br /> OWNED SCHEDULED BODILY INJURY Per accident $
<br /> _ AUTOS ONLY AUTOS ( )
<br /> HIRED NON-OWNED PROPERTY DAMAGE
<br /> ✓ AUTOS ONLY ✓ AUTOS ONLY (Per accident) $
<br /> $
<br /> A UMBRELLA LIAB / OCCUR CPLXP-00000116 5/12/2024 5/12/2025 EACH OCCURRENCE $5,000,000
<br /> ✓ EXCESS LIAB CLAIMS-MADE
<br /> AGGREGATE $5,000,000
<br /> DED RETENTION$ _ $
<br /> C WORKERS COMPENSATION 9264599-23 11/21/2023 11/21/2024 �/ STATUTE OERH
<br /> AND EMPLOYERS'LIABILITY Y/N
<br /> ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $1,000,000
<br /> OFFICER/MEMBEREXCLUDED? 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 /> B Excess Liability-U/L CPLXP-00000116 LHA600422 5/12/2024 5/12/2025 $3,000,000 Each Occ/Agg
<br /> D Contractors Pollution Liability ENP0011782-01 8/23/2024 8/23/2025 $1,000,000 Each Occ
<br /> $2,500 Deductible $2,000.000 Aggregate
<br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
<br /> RE:Outdoor Library at Jerome Park;Project No.22-1381
<br /> This certificate may be relied upon only if the certificate addendum referred to herein is attached hereto.
<br /> CERTIFICATE HOLDER CANCELLATION
<br /> of SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> City
<br /> y of Santa Center Plaza
<br /> Plaza THE EXPIRATION DATE THEREOF. NOTICE WILL BE DELIVERED IN
<br /> 2ACCORDANCE WITH THE POLICY PRC\ /
<br /> Santa Ana CA 92701 0,!, s Risk ManagementDiviston
<br /> AUTHORIZED REPRESENTATIVE <' REVIEWED&APPROVED BY:
<br /> ,u Pam" A4• a Aca+r 4
<br /> G ice',
<br /> I Paul Bland `— --- Risk Management Specialist
<br /> ©1988-2015 ACORD / \
<br /> ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD
<br /> 81566780 124-25 A G W XS POLL-PP 1 Charise Ferguson 18/23/2024 1:36:48 PM (PDT) I Page 1 of 12
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