|
79/9/2025
<br /> E(MM/DD/YYYY)
<br /> A�" CERTIFICATE OF LIABILITY INSURANCE
<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: Annl Owens
<br /> AssuredPartners Design Professionals Insurance Services, LLC PHONE FAX
<br /> 3697 Mt. Diablo Blvd Suite 230 A/C No Ext: 510-272-1465 (A/c,No):
<br /> E-MLafayette CA 94549 ADDRESS: CertsDesignPro@AssuredPartners.com
<br /> INSURER(S)AFFORDING COVERAGE NAIC#
<br /> License#:6003745 INSURERA: BERKLEY INSURANCE COMPANY 32603
<br /> INSURED MIGINCO-01 INSURER B:Travelers Property Casualty Company of America 25674
<br /> MIG, Inc.
<br /> Moore Iacofano Goltsman, Inc. INsuRERc:The Travelers Indemnity Company of Connecticut 25682
<br /> 800 Hearst Ave INSURERD: National Indemnity Company 20087
<br /> Berkeley CA 94710 INSURERE: Twin City Fire Insurance Company 29459
<br /> INSURER F:
<br /> COVERAGES CERTIFICATE NUMBER:1591360611 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 INSD WVD POLICY NUMBER MM/DD MM/DD
<br /> B X COMMERCIAL GENERAL LIABILITY Y Y 6801H899998 8/31/2025 8/31/2026 EACH OCCURRENCE $1,000,000
<br /> CLAIMS-MADE � OCCUR PREMISES DAMAGE TO
<br /> PREMISES Ea occurrence)
<br /> ccurrence $1,000,000
<br /> X Contractual Liab MED EXP(Any one person) $10,000
<br /> Included PERSONAL&ADV INJURY $1,000,000
<br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000
<br /> POLICY� PECOT- LOC PRODUCTS-COMP/OP AGG $2,000,000
<br /> OTHER: $
<br /> C AUTOMOBILE LIABILITY Y Y BAOS579947 8/31/2025 8/31/2026 COMBINED SINGLE LIMIT $1,000,000
<br /> Ea accident
<br /> X ANY AUTO BODILY INJURY(Per person) $
<br /> OWNED SCHEDULED BODILY INJURY(Per accident) $
<br /> AUTOS ONLY AUTOS
<br /> X HIRED LX
<br /> NON-OWNED FIR ERTYDAMAGE $
<br /> AUTOS ONLY AUTOS ONLY Per accident
<br /> B X UMBRELLALIAB X OCCUR Y Y CUPOH758762 8/31/2025 8/31/2026 EACH OCCURRENCE $10,000,000
<br /> EXCESS LAB CLAIMS-MADE AGGREGATE $10,000,000
<br /> DED X RETENTION$n $
<br /> B WORKERS COMPENSATION Y U1321-553909 8/31/2025 8/31/2026 X PER OTH-
<br /> AND EMPLOYERS'LIABILITY Y/N STATUTE ER
<br /> ANYPROPRIETOR/PARTNER/EXECUTIVE FN] N/A E.L.EACH ACCIDENT $1,000,000
<br /> OFFICE R/M EMBER EXCLUDED?
<br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000,000
<br /> If yes,describe under
<br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000
<br /> A Professional Liab&Contr.Poll AEC909023107 8/31/2025 8/31/2026 Per Claim/$5,000,000 $5,000,000/Aggr
<br /> D Drone Liability 9004014 8/31/2025 8/31/2026 Limit $1,000,000
<br /> E Cyber Liability 57MB035552025 8/31/2025 8/31/2026 Limit $1,000,000
<br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
<br /> The following policies are included in the underlying schedule of insurance for umbrella/excess liability:General Liability/Auto Liability/Employers
<br /> Liability/Employee Benefits Liability.
<br /> Project: RFP#23-010, Project:California Environmental Quality Act(CEQA).
<br /> City of Santa Ana, its officers,officials,employees,and volunteers are named as an additional insured as respects general liability and auto liability as required
<br /> per written contract. General Liability is Primary/Non-Contributory per policy form wording. Insurance coverage includes waiver of subrogation per the attached
<br /> endorsement(s).
<br /> APPROVED
<br /> By Tu Tran Nguyen at 9:32 am,Sep 10,2025
<br /> CERTIFICATE HOLDER CANCELLATION 30 Day Notice of Cancellation
<br /> Tu Tran Digitally signedb SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> Tu Tran Nguyen THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br /> Date:2225.'0'0' ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> City of Santa Ana Nguyen 09:33:32-07
<br /> Planning and Building Agency
<br /> 20 Civic Center Plaza AUTHORIZED REPRESENTATIVE
<br /> Santa Ana CA 92701 +
<br /> ©1988-2015 ACORD CORPORATION. All rights reserved.
<br /> ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD
<br />
|