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ACORO® CERTIFICATE OF LIABILITY INSURANCE DATE1(/6�202rvYYY)
<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 Phone: (951)694-0625 CONTACT Certificate Department
<br /> Fax: (951)719-3350 NAME:
<br /> PSA Realty&Insurance Services PHOIC,NE (951)694-0625 aC No; (951)719-3350
<br /> E-MAIL certs@,psainsurancexom
<br /> PO BOX 72O ADDRESS:
<br /> Temecula,California 92593-0720 INSURERS AFFORDING COVERAGE NAICi1
<br /> INSURER A: Associated Industries Insurance Company,Inc. 23140
<br /> INSURED INSURER B: Infinity Select Insurance Company 20260K
<br /> Bridgerock Construction Inc INSURER C: Scottsdale Insurance Company 41297
<br /> 524 S 4th Avenue INSURER D: Clear Spring Property and Casualty Company 15563
<br /> La Puente,CA 91746 Westchester Surplus Lines Insurance Company 10172
<br /> INSURER E: rP p Y
<br /> INSURER F:
<br /> COVERAGES CERTIFICATE NUMBER:24313 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 ADDL SUBR POLICY EFF POLICY EXP
<br /> LTR TYPE OF INSURANCE POLICY NUMBER MMIDD/YYYY MMIDDIYYYYI LIMITS
<br /> ✓ COMMERCIAL GENERAL LIABILITY AES125969900 1/9/2025 1/9/2026 1,000,000
<br /> EACH OCCURRENCE $
<br /> ACLAIMS-MADE ✓ rr
<br /> DAMAGE TO RENTED
<br /> OCCUR PREMISES Ea occuence1 $ 100,000
<br /> ✓ Y MED EXP(Any one person) s 5'
<br /> 000
<br /> PERSONAL&ADV INJURY $ 1,000,000
<br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000
<br /> ✓ POLICY PRO ❑ 2,000,000
<br /> JECT LOC PRODUCTS-COMPIOPAGG $
<br /> OTHER: $
<br /> B
<br /> AUTOMOBILE LIABILITY 50013472201 1/9/2025 7/9/2025 COEa MBE SINGLE LIMIT $ 1,000,000
<br /> ANY AUTO BODILY INJURY(Per person) $
<br /> OWNED �/ SCHEDULED
<br /> AUTOS ONLY AUTOS N BODILY INJURY(Per accident) $
<br /> PROPERTY DAMAGE
<br /> HIRED ✓ NON-OWNED $
<br /> AUTOS ONLY AUTOS ONLY Par accident
<br /> $
<br /> UMBRELLA LAB OCCUR CXS4040896 12/30/2024 12/30/2025 EACH OCCURRENCE $ 3,000,000
<br /> C 7 EXCESS LIAB
<br /> CLAIMS-MADE AGGREGATE $ 3,000,000
<br /> DED I I RETENTION$ N $
<br /> WORKERS OT
<br /> D AND EMPLOYERSENSABIOTM ✓YIN CWCO2769201 1/9/2025 1/9/2026 STATUTE EERH
<br /> ANYPROPRIETORIPARTNERIEXECUTIVE E.L.EACH ACCIDENT $ 1,000.000
<br /> OFFICERIMEMBER EXCLUDED? ❑Y N/A N
<br /> (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 1,000.000
<br /> If yes,describe under E.L.DISEASE-POLICY LIMIT $
<br /> DESCRIPTION OF OPERATIONS below 1,000,000
<br /> L Contractors Pollution Liability N G48019307001 12/30/2024 12/30/2025 EacIt Pollution Condition 1,000,000
<br /> General Aggregate 2,000,00
<br /> DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
<br /> City of Santa Ana, officers, agents, employees, and volunteers are named as additional insured when required by
<br /> written contract, per company forms CG2033 0413 & CG2037 0704 attached. General Liability insurance is primary and
<br /> non-contributory when required by written contract, per company form NX GL 009 OB 09 attached. Waiver of subrogation
<br /> applies when required by written contract, per company form CG 24 04 05 09 attached. Excess Liability follows form
<br /> over General Liability and Automobile Liability. 30 day notice of cancellation- 10 day notice of cancellation for non
<br /> payment of premium.
<br /> CERTIFICATE HOLDER CANCELLATION
<br /> Holder's Nature of Interest:Additional Insured
<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 /> ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> Risk Management Division
<br /> 20 Civic Center Plaza AUTHORIZED REPRESENTATIVE
<br /> Santa Ana,CA 92702 a�� / )
<br /> ©1988-2015 ACORD CORPORATION. All rights reserved.
<br /> ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD APPROVED
<br /> By Luisa Najera at 4:48 pm,Jan 06,2025
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