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VIDOSAM-01 LBURRILI
<br />CERTIFICATE OF LIABILITY INSURANCE
<br />DATE(M912620120D2YYY)
<br />24
<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((es) 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 endorsements .
<br />PRODUCER
<br />Acrisure Southwest Partners Insurance Services, LLC
<br />4000 Westerly Place
<br />Suite 110
<br />CONTACT Lisa Burrill
<br />NAME:
<br />PHONE, , E> t : (809) 766-1788 FAX , No
<br />E-MAIL
<br />ADDRESS: libUrrillaCrisure.cOm
<br />Newport Beach, CA 92660
<br />INSURERS AFFORDING COVERAGE
<br />NAIL #
<br />INSURERA:Geminl Insurance Company
<br />10833
<br />INSURED
<br />INSURERS : Everest Premier Insurance Com an
<br />16045
<br />INSURER C : North American Capacity Insurance Company
<br />25038
<br />Vi'do Samarzich, Inc.
<br />INSURER D
<br />6829 Billings Place
<br />Rancho Cucamonga, CA 91701
<br />INSURER E :
<br />INSURER F ;
<br />COVERAGES CERTIFICATE NUMBER: REVISION NIIMRFR-
<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,
<br />LTR
<br />TYPE OF' INSURANCE
<br />ADDL
<br />SUBRmignmy
<br />POLICY NUMBER
<br />POLICY EEF
<br />�
<br />POLICY' EXP
<br />IMMIDDIYYYYI
<br />LIMITS
<br />A
<br />X
<br />COM'�MERCIAL. GENERAL LIABILITY
<br />CLAIMS -MADE ®DCCUP2
<br />EACH OCCURRENCE
<br />S 1'..,000,000
<br />EEEaaccar
<br />PREMISES 9r
<br />$ 100,000
<br />MED EXP (Any one ersrsrv..
<br />''..... S
<br />PERSONAL & ADV INJURY
<br />$ 1,000,000
<br />GENT
<br />AGGREGATE LIMIT APPLIES PER:
<br />POLICY JE 0- ❑ LOC
<br />GENERAL AGGREGATE
<br />$ 2,000,000
<br />PRODUCTS - COMPIOP AGG
<br />S 2,.000,00'0
<br />$
<br />OTHFR:
<br />AUTOMOBILE
<br />L.IABILITY.....
<br />COMBN:NED SINGLE LIMIT
<br />Ea accident
<br />S
<br />BODILY INJURY 'Perperson)
<br />S
<br />ANY AUTO
<br />BODILY INJURY 'Per accident
<br />'$
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />PROPERTY DAMAGE
<br />Peraccident.
<br />S
<br />H1'....RED NON -OWNED
<br />AUTOS ONLY AUTOS ONLY
<br />S
<br />A
<br />X
<br />UMBRELLA LIAR OCCUIR
<br />EACH OCCURRENCE
<br />$ 5,000,000'
<br />AGGREGATE
<br />$ 5,000,000
<br />EXCESS LIAR CLAIMS -MADE
<br />VCFX003321
<br />6/112024
<br />611/2025
<br />$
<br />DED RETENTION $
<br />B
<br />WOEPLYMBENTION"
<br />WORKERSCOMPENSATIONLIABILITYYIN
<br />ANY PROPRIETORIPPATNERIEXECUTIVE�
<br />OFFICER/MEMBER EXCLUDED?
<br />I Mkandatory in NH}
<br />If yes, descrbe under
<br />DESCRIPTION OF OPERATIONS below
<br />NIA
<br />X
<br />7600025645241
<br />512212024
<br />512212025
<br />' STATUTE 'H-
<br />'ER
<br />E.L.. EACH ACCIDENT
<br />1,000,000
<br />EL DISEASE - EA, EMPLOYE
<br />$ 1,000,000
<br />E.L. DISEASE - POLICY LIMIT
<br />1, 000,000
<br />$
<br />C
<br />Rented/Leased Equip
<br />DIN2011483-03
<br />12/2312023
<br />12/2312024
<br />Limit
<br />25,000
<br />A
<br />OCP Liab.
<br />VCGP031944
<br />6/11/2024
<br />61112025
<br />Limit/Occurrence
<br />2,000,00(1
<br />DESCRIPTION OF OPERATIONS I LOCATIONS d VEHICLES (ACORD 101, Additional Remarks Schedule,. may be attached If more space Is required)
<br />dmai@santa-ana.org
<br />Excess Liability follows form over General Liability and all applicable endorsements apply.
<br />RE: PROJECT NO, 20.6965, ATP 5063(196) - STANDARD AVE BIKEWAY FROM WARNER AVE TO 2ND ST
<br />PROJECT NO. 20-6962, ATP 5063(198) - MCFADDEN AVE BIKEWAY FROM HARBOR BLVD TO GRAND AVE
<br />PROJECT NO. 23-6707 - STANDARD AVE PAVEMENT REHABILITATION FROM WARNER AVE TO 2N'D ST
<br />PROJECT NO. 23-6705 - MCFADDEN AVE PAVEMENT REHABILITATION FROM HARBOR BLVD TO FAIRVIEW' ST
<br />SEE ATTACHED AC'ORD 101
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />CITY OF SANTA ANA THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />RISK MANAGEMENT DIVISION, 4TH FLOOR ACCORDANCE WITH THE POLICY PROVISIONS.
<br />20 CIVIC CENTER PLAZA
<br />Santa Ana, CA 92..701 AUTHORIZED REPRESENTATIVE
<br />ACORD 25 (2016103)
<br />The ACORD name and logo are registered y Cynth,ia MoraaOct 31, 2024
<br />
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