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NATIDAT-01 XOOPSARAVA
<br />s�`oRo CERTIFICATE OF LIABILITY INSURANCE
<br />DATDr/YYY)
<br />2/21122112025
<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 endorsements .
<br />PRODUCER
<br />AssuredPartners of New Jersey, LLC dba AssuredPartners of Northeastern
<br />PA
<br />1130 Highway 315
<br />Wilkes Barre, PA 18702
<br />NAMTACT Marijo Thompson
<br />PHONE FAX
<br />AIC, No, Est): (570) 277-1438 (AIC, No):
<br />sD A,1L . Marijo.Thompson@assuredpartners.com
<br />INSURERS AFFORDING COVERAGE
<br />NAICM
<br />INSURER A: Federal Insurance Company
<br />20281
<br />INSURED
<br />National Data & Surveying Services, Inc
<br />5967 W. 3rd Street
<br />Ste 206
<br />INSURER B:StarstoneNational Insurance Company
<br />25496
<br />INSURER C: Crum & Forster Insurance Company
<br />42471
<br />INSURER D:Allied World Surplus Lines Insurance Company
<br />24319
<br />INSURER E :
<br />Los Angeles, CA 90036
<br />INSURER F
<br />COVERAGES CERTIFICATE NUMBER- RacaslON MI lunco-
<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 />L
<br />TYPE OF INSURANCE
<br />ADDL
<br />D
<br />SUER
<br />YWVD
<br />POLICY NUMBER
<br />POLICY EFF
<br />D
<br />POLICY EXP
<br />0YYYYi
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />CIAIMS-MADE [)(] OCCUR
<br />X
<br />X
<br />36069778
<br />12I12024
<br />1211/2025
<br />EACH OCCURRENCE
<br />1,000,000
<br />D"EMAISEsERENTED cat
<br />1,000.000
<br />MED EXP (My... erson
<br />10,000
<br />PERSONAL&ADV INJURY
<br />11 1,000,000
<br />AGGREGATE LIMIT APPLIES PER:
<br />POLICYNwof LOC
<br />GENERAL AGGREGATE
<br />1 21000,000
<br />GEN'L
<br />X
<br />PRODUCTS - COMPIOP AGG
<br />1 21000,000
<br />OTHER:
<br />EBLIAGGREGATE
<br />11000,000
<br />A
<br />AUTOMOBILE
<br />LIABILITY
<br />EOMBINEOSINGLE LIMIT
<br />$ 1,000,000
<br />X
<br />ANY AUTO
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />X
<br />X
<br />73624017
<br />1211/2024
<br />12/1/2025
<br />BODILYrINJURv Per penuml
<br />$
<br />BODILY INJURY Per accklent
<br />$
<br />Oacc Een( AMAGE
<br />$
<br />E
<br />AUTOS ONLY AUTO$ ONLY
<br />B
<br />X
<br />UMBRELLALIAB
<br />EXCESS LIAR
<br />X
<br />OCCUR
<br />CLAIMS -MADE
<br />X
<br />X
<br />CSX00067891P-03
<br />12/1/2024
<br />121112025
<br />EACHOCCURRENCE
<br />$ 2,000,000
<br />AGGREGATE
<br />$ 2,000,000
<br />DIED X RETENTION$ O
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS'LIABILITY YIN
<br />ANY
<br />OFFICERIMEMBER EXCLUDEED ECUTIVE ❑
<br />(Mandatory In NH)
<br />yes, describe under
<br />NIA
<br />I PER OTH-
<br />STATUTE R
<br />EL EACH ACCIDENT
<br />EL
<br />L DISEASE - EA EMPLOYE
<br />E.L. DISEASE - POLICY LIMIT
<br />DESCRIPTION OF OPERATIONS below
<br />I
<br />C
<br />Excess Umbrella
<br />121112024
<br />12/1/2025
<br />Aggregate
<br />3,000,000
<br />D
<br />Professional Liabili
<br />)(
<br />�SEO-133533
<br />)(
<br />0313.2802
<br />1211/2024
<br />12/1/2025
<br />Each Occurrence/Aggr
<br />2,000,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD tal, Additional Remarks Schedule, ma be attached if more space is required
<br />When required by written Contract: City of Santa Ana its City Council, its officers, oricials, employees, agents, and volunteers are included as additional
<br />insured with regard to General Liability on a primary and non-contributory basis perform 80-02-2367; Additional Insured with regard to Auto Liability perform
<br />16-02.0292. Waiver of subrogation applies with regard to General Liability per form 80-02-2000; with regard to Auto Liability per form 16-02.0292. $2million
<br />Excess layer is follow form perform SSS EXS 0001 CW 03 21. 30 day notice of cancellation applies. Additional insured and Waiver of subrogation applies with
<br />regard to Professional Liability.
<br />oyda111911d
<br />Tu Tran � r.r9n
<br />omz. xdzsmos
<br />Nguyen APPROVED
<br />caxz:rdoadd
<br />By Tu Tfan Nguymat 9.38arm Mar 03,-2025'
<br />CERTIFICATE HOLDER CANCELLATIO
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />City of Santa Ana
<br />20 Civic Center Plaza, M-43
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />Santa Ana, CA 92701
<br />AUTHORIZEDREPRESENTATIVE
<br />�Q
<br />ACORD 25 (2016103) @ 1988-2015 ACORD CORPORATION. All rights reserved.
<br />The ACORD name and logo are registered marks of ACORD
<br />
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