|
FLEESOL-01 SMOTASKFORCE
<br />r
<br />ACOROW CERTIFICATE OF LIABILITY INSURANCE
<br />DATE(MM/DD/YYYY)
<br />8/20/2025
<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
<br />CONTACT
<br />NAME:
<br />PHONE FAX
<br />(A/C, No, Ext): (775) 829-2345 (A/C, No):(775) 827-7090
<br />AssuredPartners of NV, LLC
<br />5340 Kietzke Lane Ste 201
<br />Reno, NV 89511
<br />E-MAIL
<br />DD RIESS:
<br />INSURERS AFFORDING COVERAGE
<br />NAIC #
<br />INSURERA:Employers Mutual Casualty Company
<br />21415
<br />INSURED
<br />INSURER B : Lloyd's of London
<br />INSURER 7
<br />Fleet Solutions LLC
<br />INSURER D7
<br />169 Cadillac Place
<br />Reno, NV 89509
<br />INSURER E
<br />INSURER F :
<br />COVERAGES CERTIFICATE NUMRFR- REVISION NLIMRFR-
<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
<br />LTR
<br />TYPE OF INSURANCE
<br />ADDL
<br />INSD
<br />SUBR
<br />WVD
<br />POLICY NUMBER
<br />POLICY EFF
<br />MM/DD/YYYY
<br />POLICY EXP
<br />MM/DD/YYYY
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />rl
<br />CLAIMS -MADE X OCCUR
<br />X
<br />X
<br />BBC2991-26GL
<br />3/6/2025
<br />3/6/2026
<br />DAMAGE TO RENTED
<br />PREMISES Ea occurrence
<br />500 000
<br />$
<br />MED EXP (Any oneperson)
<br />$ 10,000
<br />PERSONAL & ADV INJURY
<br />$ 1,000,000
<br />GENT
<br />AGGREGATE LIMIT APPLIES PER:
<br />GENERAL AGGREGATE
<br />$ 2,000,000
<br />X
<br />POLICY PRO LOC
<br />PRODUCTS-COMP/OPAGG
<br />$ 2,000,000
<br />$
<br />OTHER:
<br />A
<br />AUTOMOBILE
<br />LIABILITY
<br />COMBINED SINGLE LIMIT
<br />Ea accident
<br />1,000 000
<br />$
<br />X
<br />BODILY INJURY Perperson)
<br />$
<br />ANY AUTO
<br />X
<br />6E7-08-86 --- 26
<br />3/6/2025
<br />3/6/2026
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />BODILY INJURY Per accident
<br />$
<br />PROPERTY DAMAGE
<br />Per accident)
<br />ccident
<br />$
<br />HIRED NON -OWNED
<br />AUTOS ONLY AUTOS ONLY
<br />A
<br />X
<br />UMBRELLA LIAB
<br />X
<br />OCCUR
<br />EACH OCCURRENCE
<br />$ 5,000,000
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />6J7-08-86 --- 26
<br />3/6/2025
<br />3/6/2026
<br />AGGREGATE
<br />$ 5,000,000
<br />DED RETENTION $
<br />$
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY Y / N
<br />PER OTH-
<br />STATUTE ER
<br />ANY PROPRIETOR/PARTNER/EXECUTIVE ❑
<br />OF EXCLUDED?
<br />(Mandatory in NH)
<br />N / A
<br />E.L. EACH ACCIDENT
<br />$
<br />E.L. DISEASE - EA EMPLOYEE
<br />$
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE - POLICY LIMIT
<br />$
<br />A
<br />Garagekeepers
<br />6E7-08-86 --- 26
<br />3/6/2025
<br />3/6/2026
<br />Limit of Insurance
<br />120,000
<br />B
<br />TECH C&O/Cyber Liab
<br />ESNO040289688
<br />3/18/2025
<br />3/18/2026
<br />Aggreggate
<br />1,000,000
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required)
<br />Additional Insured status applies if required by written contract or written agreement per General Liability (CG7578(2-19)) and Commercial Auto Liability
<br />(CA7270 (09-24) ). Waiver of Subrogation applies per General Liability (CG7578(2-19)). Primary and Non -Contributory basis coverage applies per General
<br />Liability (CG7578(2-19)) and Commercial Auto Liability (CA8338(7-20)). Umbrella follows form. 30 Day Notice of Cancellation 10 Day notice for non-payment of
<br />premium issued to the first named insured only.
<br />Additional Insured: City of Santa Ana, its City Council, officers, officials, employees, agents, and volunteers are to be covered as additional insureds on
<br />Contractor's CGL and AL policies with respect to liability arising out of work operations performed by or on behalf of Contractor including materials, parts,
<br />SEE ATTACHED ACORD 101
<br />CERTIFICATE HOLDER APPROVED CANCELLATION
<br />By Tu Tran Nguyen at 4:09 pm, Sep 02, 2025
<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 Digitally signed ACCORDANCE WITH THE POLICY PROVISIONS.
<br />ATTN: Joaquin Avalos TU Tran by Tu Tran
<br />20 Civic Center Plaza Nguyen
<br />Santa Ana, CA 92702 en Ng y U Date:2025.09.02
<br />16:10:26-07'00 AUTHORIZED REPRESENTATIVE
<br />ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved.
<br />The ACORD name and logo are registered marks of ACORD
<br />
|