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DATE(MM/DD/YYYY)
<br /> A�o CERTIFICATE OF LIABILITY INSURANCE F
<br /> 03/28/2025
<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 LU
<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.If
<br /> SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this L'
<br /> certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
<br /> PRODUCER CONTACT d
<br /> Aon Risk Services south, Inc. NAME:
<br /> PHONE
<br /> Franklin TN office (A/C No.Ext): (866) 283-7122 AX No.): 800-363-0105 d
<br /> 501 Corporate Centre Drive E-MAIL a
<br /> Suite 300 ADDRESS: G
<br /> Franklin TN 37067 USA
<br /> INSURER(S)AFFORDING COVERAGE NAIC#
<br /> INSURED INSURER A: Twin City Fire Insurance Company 294S9
<br /> Arcadis U.S., Inc. INSURERB: Hartford Fire Insurance Co. 19682
<br /> 630 Plaza Drive
<br /> Suite 200 INSURERC: Hartford Casualty Insurance Co 29424
<br /> Highlands Ranch CO 80129 USA INSURERD: Endurance American Insurance Company 10641
<br /> INSURERE: Hartford Accident & Indemnity company 22357
<br /> INSURER F:
<br /> COVERAGES CERTIFICATE NUMBER: 570111730422 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. Limits shown are as requested
<br /> LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MM/DD/YYYY MrWDD/YYYY LIMITS
<br /> A X COMMERCIAL GENERAL LIABILITY 20ECSOL53i8
<br /> EACH OCCURRENCE $1,000,000
<br /> CLAIMS-MADE X❑OCCUR SIR applies per policy terns & conditions T D $1,000,000
<br /> PREMISES Ea occurrence
<br /> X Contractual Liability MILD EXP(Anyone person) $10,000
<br /> PERSONAL&ADV INJURY $1,000,000 N
<br /> GEN'L AGGREGATE LIMITAPPLIES PER: GENFRALAGGREGATE $2,000,000 0
<br /> POLICY PRO LOC PRODUCTS COMPIOP AGG $2,000,000 r
<br /> co
<br /> JECT
<br /> OTHER: o
<br /> r
<br /> B AUTOMOBILE LIABILITY 20 LEN OL5319 10/01/2024 10/01/2025 COMBINED SINGLE LIMIT -
<br /> Ea accident $1,000,000
<br /> X ANY AUTO BODILY INJURY(Per person) Z
<br /> OWNED SCHEDULED BODILY INJURY(Per accident) y
<br /> AUTOS ONLY AUTOS
<br /> HIREOAUTOS NON-OWNED PROPERTYDAMAGE
<br /> ONLY AUTOS ONLY Peracciden0 V
<br /> C X UMBRELLA La
<br /> X OCCUR 20XHUOL5322 10/01/2024 10/01/2025 EACH OCCURRENCE $1,000,000 U
<br /> Umbrella
<br /> EXCESS LIAB CLAIMS-MADE AGGREGATE $1,000,000
<br /> DED X RETENTION S10,000
<br /> E WORKERS COMPENSATION AND 20WNOL5323 10/01/2024 10/01/2025 X PER STATUTE I OTH-
<br /> EMPLOYERS'LIABILITY Y/N ADS ER
<br /> ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $1,000,000
<br /> A' OFFICERIMEMBEREXCLUDED? NIA 20WBROLS321 10/01/2024 10/01/2025
<br /> (Mandatory in NH) MA, WI E.L.DISEASE-EA EMPLOYEE $1,000,000
<br /> It yes,describe under
<br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S1,000,000—
<br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space Is required)
<br /> RE: Project & Task Number: A-2022-023-03. city of Santa Ana, its officers, officials, employees and volunteers are included
<br /> as Additional Insured in accordance with the policy provisions of the General Liability and automobile Liability policies.
<br /> General Liability and Automobile Liability policies evidenced herein are Primary and Non-Contributory to other insurance
<br /> available to Additional Insured, but only in accordance with the policy's provisions. A waiver of Subrogation is granted in
<br /> favor of City of Santa Ana in accordance with the policy provisions of the General Liability, Automobile Liability and workers'
<br /> compensation policies. Tu Trdn
<br /> Nguyen APPROVED CERTIFICATE HOLDER CANCELLATION By Tu Tran Nguyen at 8:24 am,Apr Of,2025
<br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
<br /> EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE
<br /> POLICY PROVISIONS.
<br /> city Of Santa Ana AUTHORIZED REPRESENTATIVE
<br /> Attn: zed Kekula �r
<br /> 20 Civic Center Plaza, M-43 a}
<br /> Santa Ana CA 92701 USA J/J ` 'GG�sb21a7 c/ �yza _
<br /> �yy
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