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AC o® CERTIFICATE OF LIABILITY INSURANCE DATE(MMlDDlYYYY)
<br /> 04/17/2025
<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 Mark Wright
<br /> NAME:
<br /> The Liberty Company Insurance Brokers PHONE
<br /> O No Ext: (888)918-3960 WC,No
<br /> Lic#OD79653 E-MAIL mark.wright@libertycompany.com
<br /> ADDRESS:
<br /> 5955 De Soto Ave,Ste 250 INSURER(S)AFFORDING COVERAGE NAIC#
<br /> Woodland Hills CA 91367 INSURERA: Beazley Insurance Company,Inc. 37540
<br /> INSURED INSURER 8: omp State Compensation Insurance Fund 35076
<br /> Abajian Enterprise INSURER C: United Financial Casualty Co 11770
<br /> dba SoCal Removal INSURER D: Colony Insurance Co. 39993
<br /> 1640 E Edinger Ave,Unit C INSURER E:
<br /> Santa Ana CA 92705 INSURER F:
<br /> COVERAGES CERTIFICATE NUMBER: 24-25 GL BA WC POL 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
<br /> CERTIFICATE MAYBE 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 POLICY EFF POLICY EXP
<br /> LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MMIDDIYYYY MMIDDNYYY LIMITS
<br /> X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 5,000,000
<br /> CLAIMS-MADE FX OCCUR PR MISES Ea occurrence)ence $ 50,000
<br /> MED EXP(Any one person) $ 5,000
<br /> A Y ENC0004485-05 05/01/2024 05/01/2025 -PERSONAL BADVINJURY S 5,000,000
<br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 5,000,000
<br /> X JECT LOC PRODUCTS-COMP/OP AGO $POLICY ❑ PRO 5,000,000
<br /> OTHER: $
<br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000
<br /> Ea accident
<br /> X ANY AUTO BODILY INJURY(Per person) $
<br /> C OWNED SCHEDULED 022643766 12/19/2024 06/19/2025 BODILY INJURY(Per accident) S
<br /> AUTOS ONLY AUTOS
<br /> X HIRED NON-OWNED PROPERTY DAMAGE $
<br /> AUTOS ONLY X AUTOS ONLY Per accident
<br /> $
<br /> UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000
<br /> D X EXCESS LIAB CLAIMS-MADE XS177710 11/18/2024 11/18/2025 AGGREGATE S 5,000,000
<br /> DEC I I RETENTION S �/ S
<br /> WORKERS COMPENSATION X STATUTE EH-
<br /> AND EMPLOYERS'LIABILITY Y I N
<br /> ANY PROPRIETORJPARTNER/FXECUTIVE 1,000,000
<br /> B OFFICERIMEMBER EXCLUDED? El NIA913113524 05/01/2024 05/01/2025 E.L.EACH ACCIDENT $
<br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000
<br /> If yes,describe under D E.L.DISEASE-POLICY LIMIT $
<br /> DESCRIPTION OF OPERATIONS below 1,000,000
<br /> Pollution
<br /> Each Occurrence 1,000,000
<br /> A Professional Liability ENC0004485-05 05/01/2024 05/01/2025 General Aggregate 2,000,000
<br /> DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
<br /> The City of Santa Ana,its officers,officials,employees,and volunteers are included as an Additional Insureds under the Commercial General Liability on a
<br /> Primary/Non-Contributory basis when required by written contract.
<br /> Digitally signed
<br /> Tu Tran IN-u an APPROVED
<br /> Nguyen
<br /> Nguyen Dale:2W 5.04.11
<br /> 11:19 45-071w, By Tu Tran Nguyen at 11:19 am,Apr 22,2025
<br /> CERTIFICATE HOLDER CANCELLATION
<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 Attention:Planning and Bulding Agency ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> 20 Civic Center Plaza
<br /> M-19 AUTHORIZED REPRESENTATIVE
<br /> Santa Ana CA 92701 �/J�_/
<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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