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DATE(MM/DD/YYYY)
<br /> A�" CERTIFICATE OF LIABILITY INSURANCE 8/27/2025
<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: MaryCruz Facundo
<br /> ERM Insurance Brokers LLC PHONE FAX
<br /> 111 Corporate Drive, Suite 200 vC No Ext: 949-596-0291 vc,No:949-222-0445
<br /> E-MLadera Ranch CA 92694 ADDRESS: mfacundo@alkemeins.com
<br /> INSURER(S)AFFORDING COVERAGE NAIC#
<br /> License#:OM63276 INSURERA: National Union Fire Ins.Co.of 19445
<br /> INSURED KYASERV-01 INSURERB: Lexington Insurance Company 19437
<br /> KYA Services LLC
<br /> 1800 E. McFadden Ave. INsuRERc:Westchester Surplus Lines Insurance Company 10172
<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:1904839381 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 /> A X COMMERCIAL GENERAL LIABILITY Y Y 6952470 9/1/2025 9/1/2026 EACH OCCURRENCE $2,000,000
<br /> CLAIMS-MADE � OCCUR PREMISES DAMAGE TO
<br /> PREMISES Ea occurrence)
<br /> ccurrence $300,000
<br /> MED EXP(Any one person) $10,000
<br /> PERSONAL&ADV INJURY $2,000,000
<br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $4,000,000
<br /> POLICY� PECOT- LOC PRODUCTS-COMP/OP AGG $4,000,000
<br /> OTHER: PER PROJECT AGG $$15,000,000
<br /> A AUTOMOBILE LIABILITY Y Y 4629084 9/1/2025 9/1/2026 COMBINED SINGLE LIMIT $1,000,000
<br /> Ea accident
<br /> X ANY AUTO BODILY INJURY(Per person) $
<br /> OWNED X SCHEDULED BODILY INJURY(Per accident) $
<br /> AUTOS ONLY AUTOS
<br /> X HIRED X NON-OWNED FIR ERTYDAMAGE $
<br /> AUTOS ONLY AUTOS ONLY Per accident
<br /> Comp./Collision Ded. $$250/500
<br /> D UMBRELLALIAB X OCCUR Y Y 1000588259251 9/1/2025 9/1/2026 EACH OCCURRENCE $10,000,000
<br /> X EXCESS LIAB CLAIMS-MADE AGGREGATE $10,000,000
<br /> DED X RETENTION$n nn $
<br /> WORKERS COMPENSATION PER OTH-
<br /> AND EMPLOYERS'LIABILITY Y/N STATUTE ER
<br /> ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $
<br /> OFFICE R/M EMBER EXCLUDED? ❑ N/A
<br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $
<br /> If yes,describe under
<br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $
<br /> E Leased/Rented Equipment RH3J97393500 2/27/2025 2/27/2026 Ded.$2,500 $250,000
<br /> B Contractor's Professional 031565759 6/8/2025 6/8/2026 Deductible$15,000 $2mil/4mil
<br /> C Pollution Liability G74302567002 10/11/2024 10/11/2025 Aggregate/Each Occ $2mil/4mil
<br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
<br /> SEXUAL MISCONDUCT&MOLESTATION LIABILITY POLICY NUMBER: MR25ACNE LITMIT: $3,000,000 DED:$75,000
<br /> Project: P-0103792 BID-22-2755 Location:Centennial Dog Park Santa Ana,3000 W Edinger Avenue Santa Ana, CA 92704 City of Santa Ana, its officers,
<br /> officials,employees,and volunteers are named as additional insured as required by the written contract but only insofar as the operations of the insured.The
<br /> General Liability and Auto Liability are on a primary&non-contributory basis with a waiver of subrogation per attached policy endorsements.Waiver of
<br /> Subrogation for"City of Santa Ana,its City Council,officers,officials,employees,agents,and volunteers"applies in regards to the Professional Liability as
<br /> required by written contract and as referenced in the Professional Liability policy-The company agrees to waive this right of subrogation against the client of
<br /> the insured to the extent that the Insured had, prior to a claim,a written agreement to waive such rights.30 Days Notice of Cancellation for any reason, 10 Days
<br /> Notice of Cancellation for non-payment of premium.
<br /> CERTIFICATE HOLDER APPROVED CANCELLATION
<br /> By Tu Tran Nguyen at 9:40 am,Sep 08,2025 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 ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> Attn: Public Works
<br /> CIP Engineering Digitally signed
<br /> Tu Tran byT"Tran AUTHORIZED REPRESENTATIVE
<br /> 20 Civic Center Plaza Nguyen
<br /> Santa Ana CA 92701 Nguyen Date:2025.09.08
<br /> 09.40:55-07'00'
<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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