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A� " CERTIFICATE OF LIABILITY INSURANCE
<br />DATE (MM/DD/YYYY)
<br />1(MM/DD5
<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
<br />CONTACT
<br />NAME: Patty Lugo
<br />Arthur J. Gallagher Risk Management Services, LLC
<br />HON
<br />500 N. Brand Boulevard
<br />Ext : 818-449-0289 ac, No : 818-746-9954
<br />(AMAIL
<br />ADDRESS: Patty_Lugo@ajg.com
<br />Suite 100
<br />INSURER(S) AFFORDING COVERAGE
<br />NAIC#
<br />Glendale CA 91203
<br />INSURERA: National Union Fire Insurance Company of Pittsburg
<br />19445
<br />License#: OD69293
<br />INSURED JHARRIS-02
<br />INSURERB: Travelers Property Casualty Co of America
<br />25674
<br />J. Harris Industrial Water Treatment, Inc.
<br />dba Puretec Industrial Water
<br />INSURERC: Indian Harbor Insurance Company
<br />36940
<br />INSURERD: Westchester Fire Insurance Company
<br />10030
<br />3151 Sturgis Rd
<br />Oxnard CA 93030
<br />INSURER E7
<br />INSURER F :
<br />COVERAGES CERTIFICATE NUMBER: 1754943100 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
<br />LTR
<br />TYPE OF INSURANCE
<br />ADDL
<br />INSD
<br />SUBR
<br />WVD
<br />POLICY NUMBER
<br />POLICY EFF
<br />MM/DD/YYYY
<br />POLICY EXP
<br />MM/DD/YYYY
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />Y
<br />Y
<br />5268254
<br />6/30/2024
<br />6/30/2025
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />CLAIMS -MADE � OCCUR
<br />DA
<br />PREM SESOEa occurrDence
<br />$ 300,000
<br />MED EXP (Any one person)
<br />$ 5,000
<br />PERSONAL &ADV INJURY
<br />$ 1,000,000
<br />GEN'L
<br />AGGREGATE LIMIT APPLIES PER:
<br />GENERAL AGGREGATE
<br />$ 2,000,000
<br />POLICY � ECT � LOC
<br />X
<br />PRODUCTS - COMP/OP AGG
<br />$ 2,000,000
<br />$
<br />OTHER:
<br />A
<br />AUTOMOBILE
<br />LIABILITY
<br />Y
<br />Y
<br />4489737
<br />6/30/2024
<br />6/30/2025
<br />COMBINED SINGLE LIMIT
<br />Ea accident
<br />$ 1,000,000
<br />X
<br />BODILY INJURY (Per person)
<br />$
<br />ANY AUTO
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />BODILY INJURY (Per accident)
<br />$
<br />PROPERTY DAMAGE
<br />Per accident
<br />$
<br />HIRED NON -OWNED
<br />AUTOS ONLY AUTOS ONLY
<br />B
<br />X
<br />UMBRELLA LAB
<br />X
<br />OCCUR
<br />CUP-7W046040-24
<br />6/30/2024
<br />6/30/2025
<br />EACH OCCURRENCE
<br />$ 10,000,000
<br />AGGREGATE
<br />$ 10,000,000
<br />EXCESS LAB
<br />CLAIMS -MADE
<br />DED X RETENTION $ 1 n nnn
<br />$
<br />A
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY Y / N
<br />ANYPROPRIETOR/PARTNER/EXECUTIVE
<br />Y
<br />015893872
<br />6/30/2024
<br />6/30/2025
<br />X PER OTH-
<br />STATUTEI ER
<br />E.L. EACH ACCIDENT
<br />$ 1,000,000
<br />OFFICER/MEMBER EXCLUDED? FN]
<br />N/A
<br />E.L. DISEASE - EA EMPLOYEE
<br />$ 1,000,000
<br />(Mandatory in NH)
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE - POLICY LIMIT
<br />$ 1,000,000
<br />C
<br />Excess Liab $5M part of $10M
<br />SXS005939303
<br />6/30/2024
<br />6/30/2025
<br />Limit
<br />$5,000,000
<br />D
<br />Excess Liab $5M part of $10M
<br />G4866491 A 001
<br />6/30/2024
<br />6/30/2025
<br />Limit
<br />$5,000,000
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required)
<br />City of Santa Ana, its City Council, its officers, officials, employees, agents and volunteers are named as Additional Insureds with respects to General Liability
<br />per form CG 20 15 04 13 and per form CG 20 33 04 13 and Auto Liability per form 87950 (10/05). General Liability policy is primary and non-contributory per
<br />form CG 20 01 04 13. Waiver of Subrogation applies in favor of additional insureds on General Liability per form CG24040509, Auto Liability per form 62897
<br />(6/95) and Workers Compensation coverage per form WC 00 03 13. The Producer will endeavor to mail 30 days written notice to the Certificate Holder named
<br />on the certificate if any policy listed on the certificate is cancelled prior to the expiration date. Failure to do so shall impose no obligation or liability of any kind
<br />upon the Producer or otherwise alter the policy terms.
<br />Tu Tran T�Ta',N9
<br />Yen
<br />late* O 'N u e n A-0 ooAPPROVED
<br />CERTIFICATE HOLDER CANCELLATION By Tu Tran Nguyen at4:12 pm, May 01, 2025
<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
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />Attention: Susan Gorospe
<br />AUTHORIZED REPRESENTATIVE
<br />60 Civic Center Plaza M-97
<br />Santa Ana CA 92701
<br />��/A'
<br />@ 1988-2015 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD
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