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MBREYEL-01
<br />NGARCIA
<br />'4414 o CERTIFICATE OF LIABILITY INSURANCE
<br />DAT/13/2D/YYYY)
<br />2l13/2025
<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
<br />Orion Business Insurance and Risk Management Services, Inc.
<br />1250 Corona Pointe Court, Suite 302
<br />Corona, CA 92879
<br />CONTACT Noemi Garcia
<br />NAME:
<br />PAHoNt o, Ext 626 773-8488 FAX
<br />( ): ( ) (A1c, No):(951) 737-5083
<br />AEbmAR1ES5, ngarcia@orionins.com
<br />INSURERS AFFORDING COVERAGE
<br />NAIC #
<br />INSURER A:CanO ius US Insurance Inc.
<br />12961
<br />INSURED
<br />INSURER B : National Fire & Marine Insurance Company
<br />20079
<br />INSURER C : Everest Premier Insurance Company
<br />16045
<br />M. Brey, Inc., dba MBE Construction
<br />P0Box 3159
<br />Beaumont, CA 92223
<br />INSURER D :
<br />INSURER E
<br />INSURER F :
<br />COVERAGES CERTIFICATE NUMBER- PPVtctntu tut 1A0=D. 1
<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
<br />I-TR
<br />TYPE OF INSURANCE
<br />ADDL
<br />D
<br />SUBR
<br />WVD
<br />POLICY NUMBER
<br />POLICY EFF
<br />POLICY EXP
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />CLAIMS -MADE X OCCUR
<br />X
<br />X
<br />CUSP C19000173-00
<br />11/13/2024
<br />11/1312025
<br />AMAGE
<br />DN
<br />PREMISE TOEaREoccurrTED nce
<br />$ 100,000
<br />MED EXP (Any oneperson)
<br />$ Excluded
<br />PERSONAL & ADV INJURY
<br />$ 1,000,000
<br />GEN'LAGGREGATE LIMIT APPLIES PER :
<br />jECOT-
<br />GENERAL AGGREGATE
<br />$ 2,000,000
<br />POLICY LOC
<br />PRODUCTS - COMP/OP AGG
<br />$ 2,000,000
<br />X OTHER: $5,000 BI1PD Ded per Occ
<br />B
<br />AUTOMOBILE
<br />LIABILITY
<br />EOMBINdEeDtSINGLE LIMIT
<br />1,000,000
<br />$
<br />BODILY INJURY tPerperson)
<br />$
<br />ANYAUTO
<br />X
<br />72APBO10033
<br />11113/2024
<br />11/1312025
<br />OWNED AUTOS ONLY X AUTOS
<br />BODILYINJURY Peraccident
<br />$
<br />ROPERTY AMAGE
<br />Per accident
<br />$
<br />HIRED NON -OWNED
<br />AUTOS ONLY AUTOS ONLY
<br />A
<br />UMBRELLA LIAB
<br />X
<br />OCCUR
<br />EACH OCCURRENCE
<br />$ 5,000,000
<br />X
<br />AGGREGATE
<br />5,000,000
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />CUSXS20000077-00
<br />11/1312024
<br />11/13/2025
<br />DED RETENTION $
<br />C
<br />WORKERS COMPENSATION
<br />X PER OTH-
<br />STATUTE ER
<br />AND EMPLOYERS' LIABILITY YIN
<br />E.L. EACH ACCIDENT
<br />1,000,000
<br />ANY PRO PRIEGDTIVE
<br />X
<br />7600026637251
<br />2/12/2025
<br />2/12/2026
<br />FFICERIMEMBEER1 EXCLUDED' ❑
<br />Mandatory In NH)
<br />NIA
<br />E.L. DISEASE - EA EMPLOYE
<br />$ 1,000,000
<br />If yes, describe under
<br />E.L. DISEASE • POLICY LIMIT
<br />$ 1,000,000
<br />DESCRIPTION OF OPERATIONS below
<br />DIgiWyYgn
<br />Tu Tran b,r,,��
<br />Nguyen
<br />N uyen D�.:zgu.D= a APPROVED
<br />DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more sp By Tu Tran Nguyen at 3:01 pm, Feb 18, 2025
<br />Project No: PO 7933
<br />City of Santa Ana, its City Council, officers, officials, employees, agents, and volunteers are listed as additional insureds as respects General Liability and
<br />Auto Liability with respect to liability arising out of work operations performed by or on behalf of Contractor including materials, parts, and equipment
<br />furnished in connection with such work or operations and automobiles owned, leased, hired, or borrowed by or on behalf of Contractor. Primary wording is
<br />included as respects General Liability per the attached policy form. Waiver of subrogation is included as respects General Liability and Workers'
<br />Compensation per the attached policy forms. Notice of cancellation will be delivered in accordance with the policy provisions.
<br />City of Santa Ana
<br />Attn: Public Works Agency, Water Resource Division
<br />215 S. Center Street (M-85)
<br />Santa Ana, CA 92701
<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 />AUTHORIZED REPRESENTATIVE
<br />+i a
<br />AI;VKU LO (LU101U3) @ 1988-2015 ACORD CORPORATION. All rights reserved.
<br />The ACORD name and logo are registered marks of ACORD
<br />
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