SULLY-MILLER CONTRACTING COMPANY (BRISTOL ST. IMPROVEMENTS FROM WARNER AVE. TO ST. ANDREW PL.)

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A CERTIFICATE OF LIABILITY INSURANCE DATE(MWDDIYYYY) 0410212025 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(les)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER CONTACT MARSH USA,LLC. PHONE FAX 1166 Avenue of the Americas 1C.hijQ,Ex", AIC No New York,NY 10036 E-MAIL ADDRE S: INSURERS AFFORDING COVERAGE NAIc# CN101472134-HRI-Prof.24-25 Nelson INSURERA: National Fire&Marine Insurance Company 20079 INSURED - INSURER la: SULLY-MILLER CONTRACTING COMPANY 135 S.STATE COLLEGE BLVD.,STE.400 INSURER C: BREA,CA 92821 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: NYC-012256014.00 REVISION NUMBER: o THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES,LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSp WVD POLICYNUMBER MWDDNYYY) (MMIDDfYYYYI LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRFNCE $ - CLAIMS-MADE OCCUR DAMAGE TO RENTED PRE SES Ea occon'ence $ MED EXP(Anyone person) $ PERSONAE.&ADV INJURY $ GHN'L AGGREGATE LIMIT APPLIES PER: GENFRALAGGREGATE $ POLICY D JE�a LOC PRODUCTS-COMPIOP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANYAUTO BODILY INJURY(Per person) $ OWNED SCHEDULED id Per accent AUTOS ONLY AUTOS BODILY INJURY( ) $ HIRED NON-OWNED PROPERTYDAMAGE AUTOS ONLY AUTOS ONLY Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB HCLAIMS-MADE AGGREGATE $ ❑E6 RETENTION $ WORKERS COMPENSATION PERT OTHER • AND EMPLOYERS'LIABILITY ANYPROPRIETORIPARTNFR/EXECUTIVt= YIN STA UTE OFFICEWMEMBERFXCLUDED7 NI NIA E.L.EACH ACCIDENT $ (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ A CONTRACTORS'PROFESSIONAL. 42-CNP-335886.01 0710112024 D710112025 EACH CLAIM I AGG 2,000,000 LIABILITY(CLAIMS MADE) SELF INSURED RETENTION 250,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Project No.:11-6741 Bristol Street Improvements from Warner Avenue to Saint Andrew Place I Project No.:19-6499 Bristol Street(Phase 4)Water Main Job 10340704 APPROVED Sy Tu Trarr Nguyen at 9:24 am,Apr 07,2625 CERTIFICATE HOLDER CANCELLATION Cily of Santa Ana SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 20 Civic Center Plaza-City Hall,Ross Annex THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Santa Ana,CA 92701 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE of Marsh USA LLC ©1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD