|
74/7/2025
<br /> E(MM/DD/YYYY)
<br /> �� 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: Annl Owens
<br /> AssuredPartners Design Professionals Insurance Services, LLC PHONE FAX
<br /> 3697 Mt. Diablo Blvd., Suite 230 A/C No EXt: 510-272-1465 vc,No):
<br /> Lafayette CA 94549 ADDRESS: CertsDesignPro@AssuredPartners.com
<br /> INSURER(S)AFFORDING COVERAGE NAIC#
<br /> License#:6003745 INSURER A:Travelers Property Casualty Company of America 25674
<br /> INSURED ASCEENV-01 INSURER B:The Travelers Indemnity Company of Connecticut 25682
<br /> Ascent Environmental, Inc.
<br /> 455 Capitol Mall Suite 300 INSURERC: Beazley Excess and Surplus Insurance,Inc. 17520
<br /> Sacramento CA 95814-4405 INSURER D:
<br /> INSURER E:
<br /> INSURER F:
<br /> COVERAGES CERTIFICATE NUMBER:307979695 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 I POLICY NUMBER MM/DD/YYYY MM/DDIYYYY
<br /> A X COMMERCIAL GENERAL LIABILITY Y Y 6806H400124 3/15/2025 3/15/2026 EACH OCCURRENCE $2,000,000
<br /> DAMAGE TO RENTED
<br /> CLAIMS-MADE OCCUR
<br /> PREMISES Ea occurrence $1,000,000
<br /> X Contractual Liab MED EXP(Any one person) $10,000
<br /> Included PERSONAL&ADV INJURY $2,000,000
<br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $4,000,000
<br /> PRO-
<br /> POLICY� ECT1:1 LOC PRODUCTS-COMP/OPAGG $4,000,000
<br /> OTHER: $
<br /> B AUTOMOBILE LIABILITY Y Y BA4R770955 3/15/2025 3/15/2026 COMBINED SINGLE LIMIT $1,000,000
<br /> Ea accident
<br /> 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 /> X NoOwned Auto $
<br /> UMBRELLALIAB OCCUR EACH OCCURRENCE $
<br /> EXCESS LIAB CLAIMS-MADE AGGREGATE $
<br /> DED RETENTION$ $
<br /> A WORKERS COMPENSATION Y UB7K512607 3/15/2025 3/15/2026 X PER OTH-
<br /> AND EMPLOYERS'LIABILITY YIN STATUTE ER
<br /> ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $1,000,000
<br /> OFFICER/MEMBER EXCLUDED? NIA
<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 /> C Professional Liability D392EE250101 3/15/2025 3/15/2026 Per Claim $2,000,000
<br /> Aggregate Limit $4,000,000
<br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
<br /> The Named Insured has no company owned autos.
<br /> Insured owns no company vehicles;therefore,hired/non-owned auto is the maximum coverage that applies.
<br /> Project#20230169.01 -City of Santa Ana—Environmental and Planning Services On-Call
<br /> City of Santa Ana,its City Council,officers,officials, employees,agents and volunteers are named as an additional insured as respects general liability and
<br /> auto liability as required per written contract. Insurance coverage includes waiver of subrogation per the attached endorsement(s).
<br /> Digitally signed by
<br /> APPROVED Tu Tran
<br /> Tran Nguyen
<br /> By Tu Tran Nguyen at 3:31 pm,Apr 10,2025 Nguyen Date::3137-07'010
<br /> 15:31:37-07'00'
<br /> CERTIFICATE HOLDER CANCELLATION 30 Day Notice of 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 /> Attn: Planning and Building Agency
<br /> 20 Civic Center Plaza, M-20 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
<br />
|