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AC CORE)® CERTIFICATE OF LIABILITY INSURANCE DAT
<br /> ] 0E;(MMIDDNYYY)
<br /> /02/2025
<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 NAME:CT Ma Cruz Facundo
<br /> ERM Insurance Brokers LLC PHONE ext.949-596-0291 a1c No:949-222 0445
<br /> 111 Corporate Drive, Suite 200 E-MAIL
<br /> Ladera Ranch CA 92694 ADDRESS; mfacundo@alkemeins.com
<br /> INSURERS AFFORDING COVERAGE NAIC 9
<br /> Lice se 7 4 63276 INSURER A:National Union Fire Ins,Co.of 19445
<br /> INSURED KYASERV-oi INSURER13:Lexington Insurance Company 19437
<br /> KYA Services LLC INSURERC:Westchester Surplus Lines Insurance Company 10172
<br /> 1800 E. McFadden Ave.
<br /> Santa Ana CA 92705 INSURERD:Starr Indemnity&Liability Company 38318
<br /> INSURER E;The Hanover Insurance Company 22292
<br /> INSURER F;
<br /> COVERAGES CERTIFICATE NUMBER:1725632891 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 5 BR POLICY EFF POLICY EXP
<br /> LTR POLICYNUMBER MMIDDtYYYY) (MMIDD/YYYYJ LIMITS
<br /> A X COMMERCIAL GENERAL LIABILITY Y Y 6952470 9/1/2024 911/2025 EACH OCCURRENCE $2,000,000
<br /> CLAIMS-MADE I-XI OCCUR DAMAGE TO RE
<br /> PREMISES(Ea occutre ce $300,000
<br /> MED EXP(Any one person) $10,000
<br /> PERSONAL&ACV INJURY $2,000,000
<br /> nGEMLAGGREGATELIMITAPPLIESPER: GENERAL AGGREGATE $4,000,000JECTPOLICY ] PRO
<br /> ❑ LOC. PRODUCTS-COMP/CP AGG $4,000,000
<br /> OTHER: 1 1 $
<br /> A AUTOMOBILE LIABILITY Y Y 4620084 9/1/2024 9/1/2025 COMBINED SINGLELIMIT $1,000,000
<br /> Ea auddent
<br /> X ANY AUTO BODILY INJURY(Par person) $
<br /> OWNED X SCHEDULED (Par accident
<br /> AUTOS ONLY AUTOS BODILY INJURY P( ) $
<br /> X HIRED X NON-OWNED PROPERTY DAMAGE $
<br /> AUTOS ONLY AUTOS ONLY (per.
<br /> D UMBRELLA LIAB X OCCUR Y Y 10DO588259242 9/1/2024 9/1/2025 EACH OCCURRENCE $1tl,000,000
<br /> X EXCESS LIAR CLAIMS-MADE AGGREGATE $10,000,000
<br /> DEU X I RETENTION $
<br /> WORKERS COMPENSATION PER OTH-
<br /> AND EMPLOYERS'LIABILITY Y I N STATUTE ER
<br /> ANYPROPRIETORIPARTNER(EXECUTIVE ❑ MIA
<br /> E.L.EACH ACCIDENT $
<br /> OFFICEWMEMBEREXCLUDED?
<br /> {Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $
<br /> f Yea,desarlbe under
<br /> DESCRIPTION OF OPERATIONS below E,L,DISEASE-POLICY LIMIT $
<br /> E LeasedlRentadEquippment RH3J97393500 2/27/2025 2/27/2026 Ded.$2,500 $250,000
<br /> B Contractor aProfesslonal 031665769 6/8/2024 6/8/2025 1 Deductible$15,000 $1mil12mil
<br /> C Pollution Liability G74302567002 10/11/2024 10/11/2025 AggregetelEach Occ $2mi1/4mil
<br /> DESCRIPTION OF OPERATIONS!LOCATIONS 1 VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space is required)
<br /> Project:P-0103792 BID-22-2755 location:Centennial Dag Park Santa Ana,3000 W Edinger Avenue Santa Ana,CA 92704
<br /> City of Santa Ana,its officers,officials,employees,and volunteers are named as additional insured as required by the written contract but only insofar as the
<br /> operations of the insured.The General Liability and Auto Liability are on a primary&non-contributory basis with a waiver of subrogation per attached policy
<br /> endorsements.Waiver of Subrogation for"City of Santa Ana,its City Council,officers,officials,employees,agents,and volunteers"applies In regards to the
<br /> Professional Liability as required by written contract and as referenced in the Professional Liability policy-The company agrees to waive this right of
<br /> subrogation against the client of the Insured to the extent that the Insured had,prior to a claim,a written agreement to waive such rights.
<br /> 30 Days Notice of Cancellation for any reason,10 Days Notice of Cancellation for non-payment of premium.
<br /> CERTIFICATE HOLDER AtPPRQVj� rv .x CANCELLATION
<br /> By Tu Tran Nguyen at 2:51 pm,Apr t12,21725
<br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br /> City of Santa Ana (Diyealgsiyned ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> Attn: Public Works TU Tram'IyTuTran
<br /> CIP Engineering Ng n25.ca.e2
<br /> 20 Civic Center Plaza NgUY h 14:51A2-0%0' 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
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