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.4C�® DATE(MMIDDIYYYY)
<br /> AC� CERTIFICATE OF LIABILITY INSURANCE F311 312 42 5
<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 /> Alllant Insurance Services, Inc. PIAiONE Yvonne Chong FAX
<br /> 18100 Von Karm an, 10th Floor c No E -949.660.5967 AIC No:
<br /> Irvine CA 92612 ADDRESS: chop alliantcom
<br /> INSURER($)AFFORDING COVERAGE NAIL#
<br /> INSURERA: Federal Insurance Company 20281
<br /> INSURED INSURERB: Executive Risk Indemnity Inc 35181
<br /> Macro-Z-Technology Company
<br /> 841 E Washington Ave. INSURER c:Allied World National Assuranc 10690
<br /> Santa Ana CA 92701 INSURERD:Starr Indemnity&Liability Co 38318
<br /> INSURER E: Berkley Assurance Company 39462
<br /> INSURER F
<br /> COVERAGES CERTIFICATE NUMBER.1723370536 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 TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS
<br /> LTR. POLICYNUMBER MMIDDIYYYY MMIDDIYYYY
<br /> B X COMMERCIAL GENERAL LIABILITY 54309459-03 10/112024 10/1/2025 EACH OCCURRENCE $1,04D,0D0
<br /> CLAIMS-MADE OCCUR DAMAGE TD RENc
<br /> 111
<br /> P REMISES Ea occ urrence $10D,000 VIED EXP(Any one person) $5,000
<br /> PERSONAL&ADV INJURY $1,000,000
<br /> GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000
<br /> POLICY PRO- LOC PRODUCTS-COMPIOP AGG $2,000,000
<br /> OTHER: Deductible $5,000
<br /> A AUTOMOBILE LIABILITY 54309639 10/1/2024 10/112025 COMBINED SINGLE LIMIT $1,400,000
<br /> Ea accident
<br /> X ANY AUTO BODILY INJURY(Per persnn) $
<br /> X OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) $
<br /> X HIRED X NON-OWNED PROPERTY DAMAGE $
<br /> AUTOS ONLY AUTOS ONLY Per accident
<br /> Deductible $$2,5001$5,000
<br /> G X UMBRELLALIAB X OCCUR 03115450-03 10/1/2024 1011/2025 EACH OCCURRENCE $18,000,000
<br /> EXCESS LIAB 1000586615241-03 10/1/2024 10/1/2025
<br /> CLAIMS-MADE AGGREGATE $18,000.000
<br /> QED X RETENTION$ $
<br /> A WORKERS COMPENSATION 54309538 10/1/2024 1011/2025 X STATUTE ERH
<br /> AND EMPLOYERS'LIABILITY Y 1 N
<br /> ANYPROPRIETORIPARTNERIEXECUTIVE ❑ NIA F .EACH ACCIDENT $1,000,000
<br /> OFFICERIMEMBER EXCLUDED?
<br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000,000
<br /> If ycs,describe under
<br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000
<br /> E Profess iona€lPoltution PCXB-5026074-1024 10/1/2024 10/1/2025 Each Claim $5,000.000
<br /> Aggregate regate $5,000,000
<br /> S
<br /> $25,000
<br /> DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached if more space is required)
<br /> Re: Contract:A-2022-065-02-Provide On-Call Demolition Services for the City of Santa Ana.
<br /> The City of Santa Ana, its officers,officials,employees,and volunteers are named as additional insured as respects General and Auto Liability pursuant to
<br /> written contract,agreement,or memorandum of understanding. Such insurance as is afforded by this policy shall be primary,and any insurance carried by City
<br /> shall be excess and noncontributory. Waiver of subrogation applies to Workers'Compensation. 34 Days Notice of Cancellation with 10 Days Notice for
<br /> Non-Payment of Premium in accordance with the policy provisions.
<br /> APPROVED
<br /> By Tu Tran Nguyen at 3:29 pm, Mar 17, 2025
<br /> CERTIFICATE HOLDER CANCELLATION 30 D
<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 ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> Attn: Public Works Agency, CIP/Design Engineering
<br /> 20 Civic Center Plaza AUTHORIZED REPRESENTATIVE
<br /> Santa Ana CA 92702, M-36
<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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