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• <br /> ACORD® CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) <br /> 11/08/2024 <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 CONTACT Automatic Data Processing Insurance Agency,Inc. <br /> Automatic Data ProcessingInsurance Agency, Inc. PHONE 1-800-524-7024 FAX <br /> No): <br /> (A/C,No,Extl: <br /> E-MAIL <br /> ADDRESS: <br /> 1 Adp Boulevard INSURER(S)AFFORDING COVERAGE NAIC# <br /> Roseland NJ 07068 INSURER A: The Pie Insurance Company 21857 <br /> INSURED Jarrar,Ahmad INSURER B: <br /> INSURER C: <br /> DBA:Maj Engineering INSURER D: <br /> 14608 Fawn Path Road INSURER E: <br /> Chino Hills CA 91709 INSURER F: <br /> COVERAGES CERTIFICATE NUMBER: 3943542 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 LIMITS <br /> LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) <br /> COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ <br /> DAMAGE TO REN rED <br /> CLAIMS-MADE OCCUR PREMISES(Ea occurrence) $ <br /> MED EXP(Any one person) $ <br /> PERSONAL BADV INJURY $ <br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ <br /> POLICY PRO- <br /> JECT LOC PRODUCTS-COMP/OP AGG $ <br /> OTHER: <br /> AUTOMOBILE LIABILITY COa aBINEDt)SINGLE LIMIT $ <br /> (EcANY AUTO BODILY INJURY(Per person) $ <br /> OWNED SCHEDULED BODILY INJURY(Per accident) $ <br /> AUTOS ONLY AUTOS <br /> _ PROPERTY DAMAGE <br /> HIRED NON-OWNED $ <br /> AUTOS ONLY AUTOS ONLY (Per accident) <br /> $ <br /> UMBRELLA LIAB OCCUR EACH OCCURRENCE $ <br /> EXCESS LIAB CLAIMS-MADE AGGREGATE $ <br /> DED RETENTION$ $ <br /> WORKERS COMPENSATION X STATUTE EER PER H <br /> AND EMPLOYERS'LIABILITY 1,000,000 <br /> A ANY OFFICER/MEMBER EXCLUDED?PROPRIETOR/PARTNER/EXECUTIVE YYN N/A Y WCPI1381000-000 06/25/2024 06/25/2025 E.L.EACH ACCIDENT $ <br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 <br /> If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,040,000 <br /> DESCRIPTION OF OPERATIONS/LOCATIONS 1 VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) <br /> This certificate of insurance includes a Waiver of Subrogation in favor of the certificate holder. <br /> CERTIFICATE HOLDER CANCELLATION <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 ACCORDANCE WITH THE POLICY PROVISIONS. <br /> ATTN:Risk Management Division,4th Floor <br /> AUTHORIZED REPRESENTATIVE <br /> 20 Civic Center Plaza <br /> Santa Ana CA 92701 Jtm �'t1 L w <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 />