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<br />AL� o CERTIFICATE OF LIABILITY INSURANCE
<br />SC TES
<br />DATE 0f24
<br />1211912024
<br />121191
<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 License # 0757776
<br />HUB International Insurance Services Inc.
<br />4695 MacArthur Court
<br />Suite 600
<br />NONTACT
<br />PHONE
<br />INC. Ne, Eat): (949) 623.3980 �AA/c, Na):(949) 891-0407
<br />AEMSS-
<br />Newport Beach, CA 92660
<br />INSURER $ AFFORDING COVERAGE
<br />NAIC N
<br />INSURERA:CUMIS Insurance Society, Inc.
<br />10847
<br />INSURED
<br />INSURER B :Travelars Property Casualty Company of America
<br />25674
<br />INSURER C:CorePointe Insurance Company
<br />10499
<br />T.E Roberts, Inc.
<br />17771 Mitchell North
<br />Irvine, CA 92614
<br />INSURER D:Indian Harbor Insurance Company
<br />36940
<br />INSURER E
<br />INSURERF:
<br />COVERAGES rFRTIFIr:ATF NI IMRFR-
<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 />INT.SR
<br />TYPE OF INSURANCE
<br />ADOL
<br />SUBR
<br />POLICY NUMBER
<br />POLICY EFF
<br />POLICY EXP
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL L[ABILITY
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />CLAIMS -MADE X OCCUR
<br />X
<br />X
<br />328242
<br />9/112024
<br />9/112025
<br />DAMAGETORENTED
<br />PREM aocc.m
<br />100,000
<br />MED EXP (Any one erson
<br />51000
<br />PERSONAL SADV INJURY
<br />11000,000
<br />AGGREGATE LIMIT APPLIES PER:
<br />X
<br />GENERALAGGREGATE
<br />2,000,000
<br />GEN-L
<br />PRODUCTS -COMPIOPAGG
<br />2,000,000
<br />POLICY JET LOC
<br />OTHER:
<br />A
<br />AUTOMOBILE
<br />LIABILITY
<br />EOMBINtlEED SINGLE LIMB
<br />ace0
<br />1,000,00a
<br />X
<br />$
<br />BODILY INJURY Perparson)
<br />ANYAUTO
<br />X
<br />X
<br />323243
<br />91112024
<br />9/112025
<br />OWNED SCHEDULED
<br />BODILY INJURY Per acadent
<br />$
<br />AUTOS ONLY AUTOS
<br />ASR OS ONLY AL CPS ONL�
<br />ROPERTY AMAGE
<br />Per accitlenl
<br />$
<br />B
<br />X
<br />UMBRELLA LIAB
<br />X
<br />OCCUR
<br />EACH OCCURRENCE
<br />$ 10,000,000
<br />AGGREGATE
<br />$ 10,000,000
<br />EXCESS LIAB
<br />CLAIMS MADE
<br />CUP-5T795224.24-NF
<br />9/112024
<br />9/1/2025
<br />DEp I X I RETENTIONS 10,000
<br />C
<br />NDEPLCOMPENSATION
<br />TA
<br />XSTUT RH
<br />AMOY EMPLOYERS' LIILIITY
<br />ANY PROPRETOR/PARTNEWEXECUTIVE YIN
<br />X
<br />CTP1002817
<br />9/112024
<br />91112025
<br />E.L. EACH(adstryn)E%CLUDEp4 ACCIDENT
<br />1,000,000
<br />MnoIn
<br />N/A
<br />EL DISEASE -EA EMPLOYE
<br />$ 1,000,000
<br />'As, tlescribe under
<br />E.L. DISEASE -POLICY LIMB
<br />1,00o,000
<br />DESCRIPTION OF OPERATIONS below
<br />p
<br />Professional Liab,
<br />PEC005263606
<br />9/1/2024
<br />911/2025
<br />Per Occurrence
<br />2,000,000
<br />D
<br />Contr Pollution Liab
<br />PEC005263606
<br />91112024
<br />91112025
<br />Aggregate
<br />10,000,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
<br />Re: On Call Emergency Water and Sewer Clean Up Services RFP 24-054
<br />City of Santa Ana, its City Council, its officers, officials, employees, agents, and volunteers are included as additional Insureds as respects General Liability
<br />and Auto Liability. Coverage is primary and non-contributory, subject to the terms and conditions of the policy and attached forms. Waiver of subrogation
<br />applies as respects general liability, auto liability, and workers' compensation, as required by written contract, per the attached forms. Excess liability is
<br />following form. Separation of Insureds applies. 30 day notice of cancellation, except 10 days for non-payment.
<br />APPROVED
<br />CERTIFICATE HOLDER CANCELLA BY Cynthia Mora at 9:16 am'Jan 14, 2025
<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 />PWA Water Resources Division
<br />220 S. Daisy Ave - M85
<br />Santa Ana, CA 92703 AUTHORIZED REPRESENTATIVE
<br />ADORD 25 (2016103) 9)1988.2015 ACORD CORPORATION. All rights reserved.
<br />The ACORD name and logo are registered marks of ACORD
<br />
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