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Last modified
5/20/2025 4:34:27 PM
Creation date
3/27/2025 8:34:56 AM
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Contracts
Company Name
PSOMAS
Contract #
A-2023-194-15A
Agency
Planning & Building
Council Approval Date
11/7/2023
Expiration Date
11/7/2028
Insurance Exp Date
4/1/2026
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A`� " CERTIFICATE OF LIABILITY INSURANCE <br />DATE (MM/DD/YYYY) <br />3/27/2025 <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 />Edgewood Partners Insurance Agency <br />3780 Mansell Rd. Suite 370 <br />Alpharetta GA 30022 <br />CNAOMENTACT <br />: Gre llng COI Specialist <br />PHONE FAX <br />A/C No EXt : 770.756.6599 'C' No): 770.756.6599 <br />ADDRESS: greylingcerts@greyling.com <br />INSURER(S) AFFORDING COVERAGE <br />NAIC # <br />INSURERA: National Union Fire Ins Co of Pittsburg <br />19445 <br />INSURED <br />Psomas <br />INSURER B <br />865 South Figueroa Street <br />INSURER C : <br />INSURER D : <br />Suite 3200 <br />Los Angeles CA 90017 <br />INSURER E : <br />INSURER F : <br />COVERAGES CERTIFICATE NUMBER:420765923 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 <br />LTR <br />TYPE OF INSURANCE <br />ADDL <br />I <br />SUBR <br />POLICY NUMBER <br />POLICY EFF <br />MM/DD/YYYY <br />POLICY EXP <br />MM/DDIYYYY <br />LIMITS <br />A <br />X <br />COMMERCIAL GENERAL LIABILITY <br />GL5268212 <br />4/1/2025 <br />4/1/2026 <br />EACH OCCURRENCE <br />$ 2,000,000 <br />CLAIMS -MADE OCCUR <br />DAMAGE TO RENTED <br />PREMISES Ea or <br />$ 500,000 <br />MED EXP (Any one person) <br />$ 25,000 <br />PERSONAL & ADV INJURY <br />$ 2,000,000 <br />GEN'L <br />AGGREGATE LIMIT APPLIES PER: <br />GENERAL AGGREGATE <br />$4,000,000 <br />PRO - <br />POLICY � ECT1:1 LOC <br />PRODUCTS - COMP/OPAGG <br />$4,000,000 <br />$ <br />OTHER: <br />A <br />AUTOMOBILE <br />LIABILITY <br />CA4489706 <br />4/1/2025 <br />4/1/2026 <br />COMBINED SINGLE LIMIT <br />Ea accident <br />$2,000,000 <br />X <br />BODILY INJURY (Per person) <br />$ <br />ANY AUTO <br />OWNED SCHEDULED <br />AUTOS ONLY AUTOS <br />BODILY INJURY (Per accident) <br />$ <br />X <br />PROPERTY DAMAGE <br />Per accident <br />$ <br />HIRED X NON -OWNED <br />AUTOS ONLY AUTOS ONLY <br />UMBRELLALIAB <br />OCCUR <br />EACH OCCURRENCE <br />$ <br />AGGREGATE <br />$ <br />EXCESS LIAB <br />CLAIMS -MADE <br />DED RETENTION $ <br />$ <br />A <br />A <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY YIN <br />WC72113158 (AOS) <br />WC72113159 (CA) <br />4/1/2025 <br />4/1/2025 <br />4/1/2026 <br />4/1/2026 <br />X PER OTH- <br />STATUTE ER <br />ANYPROPRIETOR/PARTNER/EXECUTIVE <br />E.L. EACH ACCIDENT <br />$2,000,000 <br />OFFICER/MEMBER EXCLUDED? <br />NIA <br />E.L. DISEASE- EA EMPLOYEE <br />$ 2,000,000 <br />(Mandatory in NH) <br />If yes, describe under <br />DESCRIPTION OF OPERATIONS below <br />E.L. DISEASE - POLICY LIMIT <br />$ 2,000,000 <br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) <br />3SAN050099; On -Call Environmental Services - CEQA and NEPA, RFQ No. 20-100. <br />City of Santa Ana, its officers, employees, agents, volunteers and representatives are named as Additional Insureds with respects to General & Automobile <br />Liability where required by written contract. The above referenced liability policies are primary & non-contributory where required by written contract. Waiver of <br />Subrogation in favor of Additional Insured(s) where required by written contract & allowed by law. <br />signed <br />Tu Tran TDu9Tran yNguyenby APPROVED <br />Date: 2025.04.02 <br />Nguyen 11:46:28.07'00 By Tu Tran Nguyen at 11:45 am, Apr 02, 2025 <br />CERTIFICATE HOLDER <br />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 <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />Planning and Building Agency <br />AUTHORIZED REPRESENTATIVE <br />20 Civic Center Plaza <br />Santa Ana CA 92701 <br />f <br />@ 1988-2015 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD <br />
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