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KANEBAL-01 MTANG2 <br /> ACORU°° CERTIFICATE OF LIABILITY INSURANCE DATE(M <br /> �►�---''' 8/4/202 YYY) <br /> 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: <br /> Acrisure West Insurance Services,LLC PHONE FAX <br /> 1950 W Corporate Way (A/C,No,Ext): (A/C,No): <br /> E-MAIL <br /> #1 ADDRESS: <br /> Anaheim,CA 92801-5373 <br /> INSURERS AFFORDING COVERAGE NAIC# <br /> INSURER A:Hartford Underwriters Insurance Company 30104 <br /> INSURED INSURER B:Insurance Company of the West 27847 <br /> Kane Ballmer$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 SUBR POLICY NUMBER IYPOLICY EFF POLICY EXP LIMITS <br /> LTR INSD WVD MM/DDYYY MM/DD <br /> A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000 <br /> CLAIMS-MADE IV OCCUR 72SBABN3SZ9 8/1/2025 8/1/2026 DAMAGE TO RENTED 1,000,000 <br /> X X PREMISES fEa occurrence $ <br /> MED EXP(Any oneperson) $ 10,000 <br /> PERSONAL&ADV INJURY $ 2,000,000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 4,000,000 <br /> X POLICY❑ PRO- ❑ LOC PRODUCTS-COMP/OP AGG $ 4,000,000 <br /> JECT <br /> OTHER: $ <br /> A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 2,000,000 <br /> Ea accident $ <br /> ANY AUTO X X 72SBABN3SZ9 8/1/2025 8/1/2026 BODILY INJURY Perperson) $ <br /> OWNED SCHEDULED <br /> AUTOS ONLY AUTOS BODILY INJURY Per accident $ <br /> X HIRED X NON-OWNED PROPERTY DAMAGE <br /> AUTOS ONLY AUTOS ONLY (per..ER <br /> $ <br /> A UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 1,000,000 <br /> EXCESS LIAB CLAIMS-MADE 72SBABN3SZ9 8/1/2025 8/1/2026 AGGREGATE $ 1,000,000 <br /> DED X RETENTION$ 10,000 $ <br /> B WORKERS COMPENSATION X PER OTH- <br /> AND EMPLOYERS'LIABILITY STATUTE ER <br /> ANY PROPRIETOR/PARTNER/EXECUTIVE Y❑ X WSA504233007 8/1/2025 8/1/2026 E.L.EACH ACCIDENT $ 1,000,000 <br /> (Mandatory in NH)EXCLUDED? N/A 1,000,000 <br /> E.L.DISEASE-EA EMPLOYEE $ <br /> If yes,describe under 1,000,000 <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ <br /> C Professional Liab. LAW-13070-02 8/1/2025 8/1/2026 Each Claim/Aggregate 2,000,000 <br /> D Cyber Liability C-4MQ8-290366-CYBER-2025 2/28/2025 2/28/2026 AGGREGATE 1,000,000 <br /> DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if 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 form and Workers Compensation endorsement. <br /> Tu Tran Digitally signed byTu <br /> Tran Nguyen <br /> Nguyen 1D1 45 54-07 00 4APPROVED <br /> By Try Tran Nguyen at 1145 am,Aug 04,2p2 . <br /> CERTIFICATE HOLDER CANCELLATION 1--------------------------------------- <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 /> Y 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 />