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KANEBAL-01 YCORAT ERS
<br /> CERTIFICATE OF LIABILITY INSURANCE DaT 2/1012Q2510l2
<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 CONTACT Mary Tang
<br /> NAME:
<br /> Acrisure Southwest Partners Insurance Services,LLC PHONE FAX
<br /> 4000 Westerly Place (PdC,No,Ext): (Arc,No):
<br /> Suite 110 E-MADDRESS,mtang aCrISLIre.Com
<br /> Newport Beach,CA 92660 INSURERS AFFORDING COVERAGE NAIC#
<br /> INSURER A:Sentinel Insurance Company, Ltd 11000
<br /> INSURED INSURER B:Insurance Company of the West 27847
<br /> Kane Ballmer 8r Berkman ALC INSURER C:QBE Insurance Corporation 39217
<br /> 515 S. Figueroa St,Suite 780 INSURER D:Coalition Insurance Company 29530
<br /> Los Angeles,CA 90071
<br /> INSURER E
<br /> INSURER F:
<br /> COVERAGES CERTIFICATE NUMBER: 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 SUB POLICY NUMBER POLICY EFF POLICY EXP LIMITS
<br /> A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 2,000,000
<br /> CLAIMS-MADE ® OCCUR X X 72SBAIT8387 811l2024 81112025 DAMAGE TO RENTEDPREMISES�Fa occurrence) $ 11000,000
<br /> MED EXP(Any one arson $ 10,000
<br /> PERSONAL&ADV INJURY $ 21000,000
<br /> GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 4,000,000
<br /> X POLICY❑ JPERO LOC PRODUCTS-CCMPIOP AGG $ 4,000,0©{}
<br /> OTHER: $
<br /> A AUTOMOBILE LIABILITY COMBINEDident $SINGLE LIMIT 2,000,000
<br /> Ea acc
<br /> ANY AUTO X X 72SBAIT8387 811l2024 8/112025 BODILY INJURY Perperson) $
<br /> OWNED SCHEDULED
<br /> AUTOS ONLY AUTOS BODILY INJURY Per accident $
<br /> AU XAJiaL e�adenoAMAGE
<br /> QSXTQSONLY ONLY
<br /> Pc $
<br /> $
<br /> A X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,000
<br /> EXCESS LIAB CLAIMS-MADE 72SBAIT8387 8/112024 811/2025 AGGREGATE s 1,000,(100
<br /> DED I X RETENTION$ 10,000
<br /> 5
<br /> B WORKERS COMPENSATION X PER OTH-
<br /> AND EMPLOYERS'LIABILITY STATUTE ER
<br /> ANY PROPRIETORIPARTNERIEXECUTIVE YrN X WSA504233006 811l2024 81112025 1,000,000
<br /> OFFICEWMEMBER EXCLUDED? N f a E.L.EACH ACCIDENT S
<br /> {Mandatory In NH) E.L.DISEASE-EA EMPLOYEE S 1,000,000
<br /> If yes,describe under 1,000,000
<br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S
<br /> C Professional Liab. LAW-13070-01 81112024 8/1/2025 Each Claim/Aggregate 2,000,000
<br /> D Cyber Liability C4MQ8-290366CYBER 2/2812024 2/2812025 AGGREGATE 1,000,000
<br /> DESCRIPTION OF OPERATIONS 1 LOCATIONS!VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached It more space is required)
<br /> The City of Santa Ana,its City Council,officers,officials,employees,agents and volunteers are additional insureds as respects attached General Liability
<br /> endorsement.Such insurance is primary and non-contributory as per attached General Liability form.
<br /> Waiver of subrogation applies as per attached General Liability and Workers Compensation forms.
<br /> APPROVED
<br /> Tu Tra n Digitally signed by
<br /> ru rran Nguyen By Tu Tran Nguyen of 5:96 pm, Feb 90, 2025
<br /> Nguyen
<br /> Date:2025.02.10
<br /> 17:17:15-08'00'
<br /> CERTIFICATE HOLDER CANCELLATION
<br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> City of Santa Ana THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br /> ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> Finance and Management Services Agency
<br /> 20 Civic Center Plaza
<br /> Santa Ana,CA 92701 AUTHORIZED REPRESENTATIVE
<br /> ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION, All rights reserved.
<br /> The ACORD name and logo are registered marks of ACORD
<br />
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