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4COR0® CERTIFICATE OF LIABILITY INSURANCE <br />`� <br />GATE/ <br />04122/222/202424 <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 be endorsed. If SUBROGATION IS WAIVED, subject to <br />the terms and conditions of the policy, certal (polici n; rI$aarl e I f a (Mendemtatemenjton hiss eertiRcate does not confer rights to the <br />e to I eu of such endorsements . r IIsigned p A <br />_ <br />u ER 51-656-2409 951- :81 3900 <br />C arry I ance ervices Lic. OD208rI; Aceved <br />19510 Van Buren Blvd. <br />F , Date: <br />id _ <br />NAr e: Patrick M&Carry <br />acC.Nc E .951-656-2409 FA Ne:951-281-3900 <br />Eo Es a c <br />U E VERAGE <br />NAIC 11 <br />INSURERA: Evanston Insurance Company <br />35378 <br />INSU EG 10- 8- 292 310-54$ 5 <br />Berg & Associates, Inc. <br />302 W. 5th Street, Suite 210 <br />San Pedro, CA90731 <br />INSURERS: Security National Insurance Company <br />19879 <br />INSURERC: Houston Specialty Insurance Company <br />12936 <br />INSURERD: StarStone National Insurance Co. <br />25496 <br />INwRERE: U.S. Specialty Insurance Company <br />29599 <br />NSURERF: <br />COVERAGES CERTIFICATE NUMBER: REVISION NUMRFR• 1`12 <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 />L <br />POLICY NUMBER <br />POLICY EFF <br />MMNO <br />POLICY UP <br />MMNID <br />LIMITS <br />A <br />GENERAL LIABILITY <br />✓ COMMERCIAL GENERAL UABIUTY <br />CLAIMS -MADE �✓ OCCUR <br />3AA760781 <br />03/01/2024 <br />03/01/2025 <br />EACH OCCURRENCE <br />$ 1 O0O 000 <br />PREMISES ERE nonce <br />$ 10O 000 <br />MED UP (Any one person) <br />$SOOO <br />PERSONAL S ADV INJURY <br />$1 00O 000 <br />GENERAL AGGREGATE <br />$ 2 OOO OOO <br />GEML AGGREGATE LIMITAPPUES PER: <br />PRODUCTS-COMP/OPAGG <br />$1000000 <br />✓ POLICY PR6 LOC <br />$ <br />B <br />AUTOMOBILE <br />LIABILITY <br />ANY AUTO <br />SPP 1808450-01 <br />03101/2024 <br />03/01/2025 <br />COMBINED SINGLE UMIT(Ea accident) <br />1000000 <br />✓ <br />BODILY INJURY (Per person) <br />$ <br />ALL OWNED SCHEDULED <br />AUTOS AUTOS <br />BODILY INJURY Per accident <br />( I <br />$ <br />HIRED AUTOS AUTOS NED <br />AUTOS <br />PROPERTY DAMAGE <br />Per actltlent <br />$ <br />Medical <br />$ 5 000 <br />C <br />UMBRELLA LMB <br />EXCESS LIMB <br />✓ <br />OCCUR <br />CLAIMSIUADE <br />ESB-HS-UCX-0000862-00 <br />03/28/2024 <br />0301-2025 <br />EACH OCCURRENCE <br />E 4,000,000 <br />✓ <br />AGGREGATE <br />$4,000,000 <br />DED RETENTION$ <br />$ <br />D <br />WORKERS COMPENSATION <br />ANDEMPLOYERS'LUIBILITY YIN <br />OFFICER/MEMBEREXCUDEDTECUIIVE❑ <br />NIA <br />T 10241022 <br />03/01/2024 <br />03/01/2025 <br />✓ WC STATU- OTH- <br />E.L. EACH ACCIDENT <br />$1 OOOOOO <br />E.L. DISEASE - EA EMPLOYEE <br />$ 1 000 000 <br />(Mandatory In NH) <br />If es, describe under <br />DESCRIPTION OF OPERATIONS below <br />EL DISEASE - POLICY LIMIT <br />$ 1,000,000 <br />Liability each claim: $1,000,000 <br />E <br />Professional Liability <br />T, <br />USS 24 34538 <br />03/01/2024 <br />03/01/2025 <br />Aggregate: $2,000,000 <br />DESCRIPTION OFOPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) <br />Re: Ritchey Improvement Projects No. 19-6438, 19-6439, 19-6440 <br />Attachments: CG2033 1219, Primary & N/C 2001-0413, Waiver of Subrogation MEGL 0241-01 05 16 <br />,k Management Division <br />Civic Center Plaza <br />Tta Ana, CA 92702 <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF un-nrc wit I RF nFI IVFRFn IN <br />ACCORDANCE WITH THE POLICY PR( <br />AUTHORUEO REPRESENTATIVE <br />i) <br />Ride Mmq nen1 DWIon <br />REVIEWED ✓S APPRW®BY: <br />�'. <br />® <br />Rnk Management Specialist <br />ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD <br />