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�"...4141 FCSINTE-01 MCCOWANA
<br /> '4��R� CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY)
<br /> 12/26/2024
<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#0E67768 CONTACT Lea Coleman
<br /> NAME:
<br /> IOA Insurance Services PHONE
<br /> 3636 Nobel Drive (A/C,No,Ext):(619)400-1996 I FAX
<br /> (A/C,No):
<br /> Suite 410 E-MAIL lea.coleman@ioausa.com
<br /> San Diego,CA 92122 ADDRESS:
<br /> INSURER(S)AFFORDING COVERAGE NAIC#
<br /> INSURER A:RLI Insurance Company 13056
<br /> INSURED INSURER B:Hudson Insurance Company 25054
<br /> FCS International,Inc. INSURER C:
<br /> 250 Commerce,Suite 250 INSURER D:
<br /> Irvine,CA 92602
<br /> INSURER E:
<br /> INSURER F:
<br /> COVERAGES CERTIFICATE NUMBER: 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 SUER POLICY NUMBER POLICY EFF POLICY EXP LIMITS
<br /> LTR JNS�WVD (MM/DDIYYY(t (MM/DDJYYYY)
<br /> A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
<br /> CLAIMS-MADE X OCCUR X X PSB0008629 1/1/2025 1/1/2026 paEMISESMoccu Mnce) $ 1,000,000
<br /> X Cont Liab/Sev of Int MED EXP(Any one person) $ 10,000
<br /> PERSONAL&ADV INJURY $ 1,000,000
<br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000
<br /> POLICY X ECT LOC PRODUCTS-COMP/OPAGG $ 2,000,000
<br /> OTHER: Dec $ 0
<br /> A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000
<br /> (Ea accident) $
<br /> _ ANY AUTO X PSA0002832 1/1/2025 1/1/2026 BODILYINJURY(Perperson) $
<br /> OWNED SCHEDULED
<br /> _ AUTOS ONLY AUTOS BODILY INJURY(Per accident) $
<br /> X HIRED X NON-OWNED PROPERTY DAMAGE
<br /> AUTOS ONLY AUTOS ONLY (Per accident) $
<br /> X NNutoCs.Owned
<br /> . $
<br /> A UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000
<br /> X EXCESS LIAB CLAIMS-MADE PSE0004283 1/1/2025 1/1/2026 AGGREGATE $ 5,000,000
<br /> DED X RETENTION$ 0 $
<br /> A WORKERS COMPENSATION X ER P OTH-
<br /> AND EMPLOYERS'LIABILITY Y!N STATUTE ER
<br /> ANY PROPRIETOR/PARTNER/EXECUTIVE X PSW0004799 1/1/2025 1/1/2026 1,000,000
<br /> E.L.EACH ACCIDENT $
<br /> (Mand atory in NH)EXCLUDED? N/A 1,000,000
<br /> E.L.DISEASE-EA EMPLOYEE $
<br /> If yes,describe under 1,000,000
<br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $
<br /> B Professional Liab. PRB0619120077 1/1/2025 1/1/2026 Per Claim 2,000,000
<br /> B Ded.:$50k Per Claim PRB0619120077 1/1/2025 1/1/2026 Ann Aggregate 4,000,000
<br /> DESCRIPTION OF OPERATIONS/LOCATIONS!VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
<br /> Re:COSA
<br /> City of Santa Ana is Additional Insureds with respect to General and Auto Liability per the attached endorsements as required by written contract.Insurance
<br /> is Primary and Non-Contributory.Waiver of Subrogation applies to General Liability and Workers'Compensation.
<br /> 30 Days Notice of Cancellation with 10 Days Notice for Non-Payment of Premium in accordance with the policy provisions.
<br /> Tu Tran Digitally signed by
<br /> _Tu Tran Nguyen APPROVED
<br /> CERTIFICATE HOLDER Nguyen uye Date:zo�s.ot.ao CANCELLATION ByTu Tran Nguyen at 8:00 am,Jan 30,2025_
<br /> '�-.,t7r-E n os:ot:aa ono.
<br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br /> ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> City of Santa Ana AUTHORIZED REPRESENTATIVE
<br /> Risk Management Division i
<br /> 20 Civic Center Plaza elt4
<br /> !Santa Ana.CA 92702 .•�� �cc
<br /> ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved.
<br /> The ACORD name and logo are registered marks of ACORD
<br />
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