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
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