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A'►`R V CERTIFICATE OF LIABILITY INSURANCE
<br />DATE,MMI°orrYYY)
<br />08/05/2024
<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($), 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
<br />CONTACT NAME: CUStnmer Service Team
<br />Preferred American Insurance
<br />PHONE (E 38) I I yy� I I N $ AncPfe
<br />AIC No Ext:
<br />P.O. BOX 79498
<br />_
<br />E-MAIL Cush nerservic @preferre america .Com
<br />ADDRESS:
<br />�
<br />1 l�
<br />OVERAGE
<br />NAIC Yk
<br />R
<br />5 Insurance Company
<br />39993
<br />CoronaAnnee A 287 p.N/
<br />INSURED
<br />INSURERS: vele a' evs p A a
<br />1'9
<br />TSG Enterprises, Inc.
<br />INSURER C Employers Insurancet Group
<br />10346
<br />dba: The Solis Group
<br />INSUF.EP u : Underwri t o of London
<br />1120203
<br />3452 E. Foothill Blvd, Suite 200
<br />INSURER E :
<br />Pasadena CA 91107
<br />INSURER F
<br />COVERAGES CERTIFICATE NUMBER; 23-25 Update Ren Certs 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 CONTRACTOR 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
<br />LTR
<br />TYPE OF INSURANCE
<br />INSD
<br />WVD
<br />POLICYNUMBER
<br />POLICY EFF
<br />MMIDDIYYYY
<br />POLICY EXP
<br />MWDDfYYYY
<br />LIMITS
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />EACH OCCURRENCE
<br />$ 1,000.000
<br />❑X OCCUR
<br />A ENTEO
<br />DAMCLAIMS-MADE
<br />PREMISES Ea occurcence
<br />S 100,000
<br />MED EXP (Any one person)
<br />$ 5,000
<br />PERSONAL & ADV INJURY
<br />$ 1,000,000
<br />A
<br />Y
<br />6COGL0005702-13
<br />08/20/2023
<br />01/01/2025
<br />GEN'LAGGREGATE LIMITAPPLIES PER:
<br />GENERAL AGGREGATE
<br />$ 2,000,000
<br />POLICY �X PRO LOC
<br />JECT
<br />PRODUCTS-COMPIOPAGG
<br />$ 2,000,ODO
<br />$
<br />OTHER'
<br />AUTOMOBILE
<br />LIABILITY
<br />COMBINED SINGLE LIMIT
<br />Ea accident
<br />$ 1,000,000
<br />BODILY INJURY (Per person)
<br />$
<br />ANY AUTO
<br />OWNED SCHEDULED
<br />Y
<br />BA-BN613360-24-42-G
<br />08/20/2024
<br />08/2012025
<br />BODILY INJURY(Per accident)
<br />$
<br />IAUTOS
<br />AUTOS ONLY AUTOS
<br />PROPERTY DAMAGE
<br />$
<br />HIRED NON -OWNED
<br />IX
<br />ONLY AUTOS ONLY
<br />Per accident
<br />Uninsured motorist
<br />$ 1,000,000
<br />UMBRELLA LIAR
<br />MCLAIMS-MADE
<br />OCCUR
<br />EACH OCCURRENCE
<br />$ 4,000,050
<br />A
<br />EXCESS LIAB
<br />X34282270
<br />08/20/2023
<br />01/01/2025
<br />AGGREGATE
<br />$ 4,000,000
<br />DED I I RETENTION S
<br />$
<br />WORKERS COMPENSATION
<br />X1
<br />AND EMPLOYERS' LIABILITY YIN
<br />SPER TATUTE EORH
<br />E.L. EACH ACCIDENT
<br />$ 1,ODO,DOO
<br />G
<br />ANY PROPRIETORIPARTNERIEXECUTIVE �
<br />NIA
<br />EIG 5133951 01
<br />0110V2024
<br />01/01/2025
<br />OFFICER/MEMBER EXCLUDED.
<br />(Mandatory In NH)
<br />E.L. DISEASE - EA EMPLOYEE
<br />S 1 ,OOD,DOO
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE - POLICY LIMIT
<br />S 1,000,000
<br />Aggregate Limit:
<br />$21000,000
<br />Professional Liability (F&D)
<br />D
<br />PSM0139735382
<br />0812012023
<br />01/01/2025
<br />Per Occurrence Limit:
<br />$2,000,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required)
<br />City of Santa Ana, its officers, employees, agents, volunteers and representatives are named as Additional Insured as required by written contract.
<br />City of Santa Ana
<br />20 Civic Center Plaza
<br />Santa Ana
<br />CA 92701
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL RF DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROt
<br />AUTHORIZED REPRESENTATIVE
<br />© 1980-2015 AC
<br />} Risk Mlwugetnatt 1}tvision
<br />o RwEWED//t tTC &APAROfVMBY.'
<br />dY4
<br />Cr f, 44
<br />I®,
<br />Risk Management Specialist
<br />ACORD 25 (2016103)
<br />The ACORD name and logo are registered marks of ACORD
<br />
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