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ACCOR" CERTIFICATE OF LIABILITY INSURANCE
<br />DATE(MMlDDIYYYY)
<br />02/1012025
<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 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 pollcy(les) 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
<br />CONTACT Nataly Hague CISR
<br />James G. Parker Insurance
<br />PHONE (559) 222-7722 Fax (559) 222-1724
<br />AIC No Ext A1C No
<br />License #0554959
<br />E-MAILnhague@jgparker,com
<br />ADDRESS:
<br />P O BOX 3947
<br />INSURERS)AFFORDING COVERAGE
<br />NAIC #
<br />INSURERA: Mesa Underwriters Specially Ins Co
<br />36838.
<br />Fresno CA 93650
<br />INSURED
<br />INSURER B : Infinity Select Ins Co
<br />20260.
<br />Superior Hot Tapping Services Inc
<br />INSURER C : Scottsdale Insurance Company
<br />41297
<br />7923 Old Oak Court
<br />INSURER D : State Compensation Ins Fund
<br />35076.
<br />INSURER E: Evanston Insurance Company
<br />35378
<br />Riverside CA 9250B
<br />INSURER F :
<br />COVERAGES CERTIFICATE NUMBER: 2b-2t5 UA 24-29 WC GL REVISION NIIMRFP-
<br />THIS IS TO CERTIFY THATTHE POLICIES OF INSURANCE LISTED BELOW-M-AVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
<br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
<br />CERTIFICATE MAYBE 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 />ILTR
<br />TYPE OF INSURANCE
<br />INSD
<br />WVD
<br />POLICYNUMBER
<br />MMI�6NYYY
<br />MMIDDIYYYF POLICY Y
<br />LIMITS
<br />COMMERCIAL GENERAL LIABILITY
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />DAMAGE RE
<br />aocCLAIMS-MADE❑OCCUR PREMISET EcUrrence
<br />100,000
<br />$
<br />MED EXP (Any oneperson)
<br />$ 51000
<br />PERSONAL & ADV INJURY
<br />$ 11000,000
<br />A
<br />Y
<br />Y
<br />MPOO82001008411
<br />07/31/2024
<br />07131t2025
<br />GEN'LAGGREGATE LIMITAPPLIES PER:
<br />JECT ❑
<br />GENERAL AGGREGATE
<br />$ 2,000,000
<br />PRODUCTS - COMPIOP AGO
<br />2,000,000
<br />OTHER:
<br />AUTOMOBILE
<br />LIABILITY
<br />COMBINED SINGLE LIMIT
<br />Ea accldeni
<br />1,OOD,DOD
<br />X
<br />BODILY INJURY (Per person)
<br />$
<br />ANYAUTD
<br />B
<br />OWNED F SCHEDULED
<br />AUTOS ONLY AUTOS
<br />Y
<br />Y
<br />60001610301
<br />01/06/2026
<br />01/08/2025
<br />BODILY INJURY (Per accldeni)
<br />$
<br />HIRED NON -OWNED
<br />AUTOS ONLY AUTOS ONLY
<br />PROPERTY DAMAGE
<br />Per accident
<br />$
<br />X
<br />UMBRELLAI-JABX
<br />OCCUR
<br />EACH OCCURRENCE
<br />$ 2,000,000
<br />AGGREGATE
<br />$ 2,000,000
<br />C
<br />EXCESS LIAR
<br />CLAIMS -MADE
<br />XLS1228052
<br />0713112024
<br />07/31/2025
<br />DEfl I I RETENTION $
<br />$
<br />D
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY
<br />ANY PROPRIF.TORIPARTNFRIEXECUTIVE YIN
<br />QFFICERIMEMBER EXCLUDED?
<br />(Mandatory In NH)
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />NIA
<br />Y
<br />9334957-2024
<br />0311512024
<br />03115/2025
<br />/� STATUFE ORH
<br />E.L. EACH ACCIDENT
<br />$ 1,DOO,000
<br />E.L. DISEASE - EA EMPLOYEE
<br />$ 11000,000
<br />E.L. DISEASE - POLICY LIMIT
<br />$ 1, 000,D00
<br />Contractors Pollution wllnciderltal
<br />Aggregate Limit
<br />$2,000,000
<br />E
<br />Professional Liability
<br />CPLMOL128094
<br />12/2112024
<br />03/15/2025
<br />Each Pollution Condition
<br />$2,000,000
<br />Each Act - E&O
<br />$2,000,000
<br />DESCRIPTION OF OPERATIONS / LOCATIONS !VEHICLES (ACORD 101, Addillonal Remarks Schedule, maybe attached If more space is required) TU Tfdr) gguau,:b
<br />Certificate holder Is included as addllional Insured with respects to General Liability 9 applies
<br />p y per form CG2010 1185 attached. Waiver ofSubrogation afion a lies NgUye E'� —1.
<br />regarding the General Liability per form CG2404 1093. Waiver of subrogation applies to the Workers compensation per form 2572 attached. Additional 7 SA2.,a
<br />Insured, Waiver of Subrogation and Primary Non-contributory wording basis In respects to Auto perform 50461AlSO1, 50461SWFO1, and 500PNGVOI n ,o sxaasnrc
<br />attached.
<br />"Supercedes Certificate Issued 01-D8-25` APPROVED
<br />By Tu Tran Nguyen of 10.54 am, Feb 10, 2025
<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,Attn: Public Works Agency, ACCORDANCE WITH THE POLICY PROVISIONS,
<br />Water Resources Div (M-85)
<br />215 S Center Street AUTHORIZED REPRESENTA71VE
<br />Santa Ana CA 92701 / X Afi��
<br />V 1980.2015 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD
<br />
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