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42, <br /> ACORE> CERTIFICATE OF LIABILITY INSURANCE DATE(MMlDDIYYYI) <br /> 10/08/2024 <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 MANAL SULLIVAN <br /> Premier Service Insurance Agency NAME: <br /> Ax <br /> 501 N.Brookhurst St.Ste#150 PHONE.Extl:714-533-8600 I(NC,No):714-533-8600 <br /> Anaheim CA 92801 aoo ES5:PSIA.MANAL@YAHOO.COM <br /> INSURER(SIAFFORDINGCOVERAGE NAIC# <br /> INSURER A:SCOTTSDALE INSURANCE COMPANY 1297 <br /> INSURED MAJ ENGINEERING INSURER B: <br /> 14608 FAWN PATH RD. INSURER C: <br /> CHINO CA 91709 INSURER D: <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 IADDL SUBR POLICY EFF POLICY EXP LIMITS <br /> LTR I INSD WVD POLICY NUMBER I(MMIDD/YYYY) (MM/DD/YYYY) <br /> A • )COMMERCIAL GENERAL LIABILITY ✓ II 1 II EACH OCCURRENCE $2,000,000 <br /> Y CLAIMS-MADE OCCUR VHPUD-T 08/09/2024 08/09/2025 DAMAGE TO RFocTED 000,000 <br /> � PREMISES(Ea occurrence) <br /> MED EXP(Any one person) $5,000 <br /> PERSONAL BADVINJURY $1,000,000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $4,000,000 <br /> POLICY JE% LOC PRODUCTS-COMP/OP AGG $2,000,000 <br /> OTHER: $ <br /> AUTOMOBILE LIABILITY I I COMBINEDtSINGLE LIMIT $ <br /> ANY AUTO BODILY INJURY(Per person) $ <br /> OWNED SCHEDULED BODILY INJURY(Per accident) $ <br /> AUTOS ONLY AUTOS <br /> HIRED NON-OWNED PROPERTY DAMAGE <br /> AUTOS ONLY ,� AUTOS ONLY (Per accident) _ <br /> $ <br /> UMBRELLA LIAB <br /> OCCUR Uu EACH OCCURRENCE $ <br /> EXCESS LIAB CLAIMS-MADE AGGREGATE $ ___ <br /> DED I RETENTION$ $ <br /> WORKERS COMPENSATION PER OTH- <br /> STATUTE ER <br /> AND EMPLOYERS'LIABILITY Y/N $ <br /> ANYPROPRIETOR/PARTNER/EXECUTIVE N/A E.L.EACH ACCIDENT <br /> OFFICER/MEMBER EXCLUDED? <br /> (Mandatory in NH) E-L-DISEASE-EA EMPLOYEE $ <br /> II/EN under D E.L.DISEASE-POLICY LIMIT $ <br /> DESCRIPTION OF OPERATIONS below <br /> uu <br /> I l'I II <br /> DESCRIPTION OF OPERATIONS!LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space is required) <br /> The City of Santa Ana,Its City Council,its officers,officials,employees,agents and volunteers are to be covered as additional Insured <br /> with respect to liability arising out of work or operations performed by or on behalf of the contractor,including materials,parts,equipment, <br /> and personnel furnished in connection with such work or operations. <br /> WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO THE CITY OF SANTA ANA. <br /> WAIVER OF SUBROGATION IS INCLUDED. <br /> CERTIFICATE HOLDER CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> AND ADDITIONAL INSURED: THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> ACCORDANCE WITH THE POLICY PROVISIONS. <br /> City of Santa Ana <br /> 20 Civic Center Plaza-Ross Annex AUTHORIZED REPRESENTATIVE <br /> Santa Ana CA 92702 MANAL SULLIVAN <br /> Menai Sullivan <br /> ©1988-2015 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD <br /> Produced using Forms Boss Web software.www.FormsBoss.com;y Impressive Publishing 800 T08-1977 APPROVED <br /> By Luisa Najera at 2:27 pm,Jan 09,2025 <br />