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ACQ® DATE(MMIDDIYYYY)
<br /> `" CERTIFICATE OF LIABILITY INSURANCE 2r'11/2025
<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 CONTACT
<br /> NAME: Debbie Williams
<br /> HUB International Insurance Services Inc. No:916-993-7224O 4 cPQ BOX 255387 N
<br /> E-MAIL
<br /> Sacramento CA 95865 ADDRESS: debbie.williams@hubinternational.com
<br /> INSURER S)AFFORDING COVERAGE NAIL#
<br /> License#:0757776 INSURER A:Nautilus Insurance Company 17370
<br /> INSURED INTEDEM-01 INSURERS:Ke Risk Insurance Company 10885
<br /> Interior Demolition Inc
<br /> INSURER Pine Street suRER c:State Compensation Insurance Fund of California 35076
<br /> Newhall CA 91321 INSURER D
<br /> INSURER E:
<br /> INSURER F
<br /> COVERAGES CERTIFICATE NUMBER:454910765 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 ADDTYPE OF INSURANCE INSD WVDSUBR Y
<br /> POLICY NUMBER MMIDDrrYYY MM D LTR DfYYYY LIMITS
<br /> A X COMMERCIAL GENERAL LIABILITY Y Y ECP2035025-13 6/4/2024 6/4/2025 EACH OCCURRENCE $1,000,000
<br /> DAMAGE TO RENTED
<br /> CLAIMS-MADE 1XI OCCUR PREMISES Ea occurrence $100,000
<br /> X $5,000❑edlOccur MED EXP(Any one person) $5,000
<br /> PERSONAL&ADV INJURY $1,000,000
<br /> GEN'L AGGREGATE LIMIT APPLIES PER: GFNFRALAGGREGATE $2,000,000
<br /> POLICY� JE 6 LOC PRODUCTS-COMPIOP AGG $2,000,000
<br /> OTHER: $
<br /> B AUTOMOBILE LIABILITY Y Y BAP2035024-13 6/4/2024 614l2025 COMBINED SINGLE LIMIT $1,000,000
<br /> Ea accident
<br /> X ANY AUTO BODILY INJURY(Per person) $
<br /> OWNED SCHEDULED BODILY INJURY(Per accident) $
<br /> AUTOS ONLY AUTOS
<br /> HIRED NON-OWNF❑ PROPERTY DAMAGE $
<br /> AUTOS ONLY AUTOS ONLY Per accident
<br /> A UMBRELLA LIAB X OCCUR FFX2035026-13 6/4/2024 6/4/2025 EACH OCCURRENCE $5,000,000
<br /> X EXCESS LIAB CLAIMS-MADE AGGREGATE $5,000,000
<br /> DFD X I RETENTION$n $
<br /> G WORKERS COMPENSATION Y 1977624-24 9/2712024 9/27/2025 X I
<br /> STATUTE ERH
<br /> AND EMPLOYERS'LIABILITY Yf N
<br /> ANYPROPRIE=TOPJPARTNERIEXE;GUTIVE N!A E.L.EACH ACCIDENT $1,000,000
<br /> OFFICERIMEMBEREXCLUDED?
<br /> (Mandatory in Ni E.L.DISEASE-EA EMPLOYEE $1,000,000
<br /> If yes,describe under
<br /> DFSCRiPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000
<br /> A Professional Liability ECP2035025-13 6/4/2024 614/2025 Each ClaimlAggregate $1,000,000
<br /> Contractors Pollution Liability Each OccurrencelAgg. $1.000,000
<br /> DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
<br /> RE: Work performed by the named insured under written contract for the certificate holder.
<br /> Additional Insured: City of Santa Ana,its officers,employees, agents and representatives are named as Additional Insureds with respect to General and Auto
<br /> Liability per the attached endorsements as required by written contract. Insurance is Primary and Non-Contributory. Waiver of Subrogation applies to Workers'
<br /> Compensation. Excess Liability extends over the Auto Liability,General Liability, Contractors Pollution Liability and Professional Liability. Policies provide for
<br /> 30 Days Notice of Cancellation,except 10 Days for Non-payment of Premium,
<br /> Forms: 10217 0714,BENVCA06 0917,CA0444 1013, ECP1246 0121, ECP1248 0121,ECP1259 0121 APPROVED
<br /> 8y Tu Tran Nguyen at 2:59 pm, Feb 11,2025
<br /> CERTIFICATE HOLDER CANCELLATION
<br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES 13E CANCELLED BEFORE
<br /> THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br /> City of Santa Ana ACCORDANCE WITH THE POLICY PROVISIONS,
<br /> Attn: Public Works Agency, CIPIDesign Engine
<br /> 20 Civic Center Plaza AUTHORIZED REPRESENTATIVE
<br /> Santa Ana CA 92702 o4z"w—
<br /> (D 1988-2015 ACORD CORPORATION. All rights reserved.
<br /> ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD
<br /> THIS CERTIFICATE SUPERSEDES PREVIOUSLY ISSUED CERTIFICATE
<br />
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