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,acoRQ® CERTIFICATE OF LIABILITY INSURANCE DATE(MM,DD[YYYY) <br /> �-� 3/20/2025 <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), AUTHORIZER <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: Charise Ferguson <br /> GMGS Risk Management& Insurance Services PHONE FAX <br /> 6201 Oak Canyon, Suite 100 Arc No Ext: 949 559 3367 Arc No: <br /> f1 EMAIL <br /> Irvine, CA 92 18 ADDRESS: Charisef mgs.com <br /> INSURER(S)AFFORDING COVERAGE NAIC# <br /> www.gmgs.com OBB4519 INSURER A: Palomar Specialty Insurance Company 20338 <br /> INSURED INSURER B: Landmark American Insurance CompanY 33138 <br /> Legion Contractors, Inc. INSURER C: <br /> 445 S. Figueroa Street, Suite 2580 <br /> Los Angeles CA 90071 INSURER D: Insurance Company of the West 27847 <br /> INSURER E: <br /> INSURER F: <br /> COVERAGES CERTIFICATE NUMBER: 84452821 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 /> CERTfFICATE 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 POLICY EXP <br /> LTR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER MMILDDY EFF MM DDfYYYY LIMITS <br /> A e/ COMMERCIAL GENERAL LIABILITY CPGLP-00000114 5/12/2024 5/12/2025 EACH OCCURRENCE $1 000,000 <br /> DAMAGE TO RENTED <br /> CLAIMS-MADE ,/ OCCUR PREMISES Ea oC.'ren,,ol $50 000 <br /> MED EXP(Any one person) $Excluded <br /> PERSONAL&AOV INJURY $1,000,000 <br /> GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE s 2,0g0,000 <br /> POLICY❑ PROT- ❑ <br /> JEC LOC PRODUCTS-COMFIOP AGG $2,fl0O,000 <br /> OTHER: $ <br /> A AUTOMOBILE LIABILITY CPBAP-00000115 5/12/2024 5/12/2025 COMBINED SINGLE $1DOO,000 <br /> ✓ ANY AUTO BODILY INJURY(Per person) $ <br /> OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) .$ <br /> HIRED NON-OWNED PROPERTY DAMAGE 8 <br /> ✓ AUTOS ONLY ✓ AUTOS ONLY Per accident <br /> 3 <br /> A UMBRELLA LIAB �/ OCCUR CPLXP-00000116 5/12/2024 5/12/2025 EACH OCCURRENCE S 5,000 000 <br /> EXCESS LIAR CLAIMS-MADE AGGREGATE S 5,000,00() <br /> DED RETENTION$ _ 5 <br /> D WORKERS COMPENSATION WSD 5080936 00 11/21/2024 11/21/2025 sT.a UTE CIT <br /> ERH <br /> AND EMPLOYERS'LIABILITY Y I N <br /> ANYPROPRIETORIPARTNERIEXECUTIVE ❑ E.L.EACH ACCIDENT $1 000,000 <br /> OFFICERIM EMBER EXCLUDED? NIA <br /> (Mandatory in NH) E.L.DISEASE EA EMPLOYEE. $1 000.00 <br /> II yes,describe under <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE--POLICY LIMIT 1 $1 000 000 <br /> B Excess Liability-UIL CPLXP-00000116 LHA600422 5/12/2024 5/12/2025 $3,000,000 Each Occurrence <br /> $3,000,000 Aggregate <br /> DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES (ACORD 101,Additional Remarks Schedule.,maybe atlaehed if more space is required) Digitally signed <br /> TU Tran hyTuTrar <br /> RE:Bristol-Tolliver Street Urban Greening,Project No.:24-6600 Nguyen <br /> This certificate may be relied upon only If the cortificMe addendum referred to herein is attached hereto. Nguyen D.w:2u25.u3m <br /> Y p Y 11:32:40-07'c0' <br /> This certificate of insurance amends and supersedes any previously issued certificate. <br /> APPROVED <br /> By Tu Tran Nguyen at 11:32 am, Mar 20, 2025 <br /> CERTIFICATE HOLDER CANCELLATION <br /> City of Santa Ana SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> y THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> Attn: Public Works Agency ACCORDANCE WITH THE POLICY PROVISIONS. <br /> 20 Civic Center Plaza, 4th Fl, <br /> Santa Ana CA 92701-4058 <br /> AUTHORIZED REPRESENTATIVE <br /> Paul Bland <br /> O 1988-2015 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD <br /> 84452821 1 24-25 A @ W XS RLL I Exc1:OT3 DT4 I Charise Ferguson 13/20/2025 9;46;26 AM (PDT) I Page 1 of 13 <br />