|
A`"R" CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY)
<br /> 05/01/2025
<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 Kenneth Lee
<br /> NAME:
<br /> The Liberty Company Insurance Brokers PHONE
<br /> NNo Ext: (888)918-3960 C,No):
<br /> Lic#OD79653 E-MAIL kenneth.lee@libertycompany.com
<br /> ADDRESS:
<br /> 5955 De Soto Ave,Ste 250 INSURER(S)AFFORDING COVERAGE NAIC#
<br /> Woodland Hills CA 91367 INSURERA: American Risk Management Resource
<br /> INSURED INSURER B: United Financial Casualty Company 11770
<br /> Abajian Enterprise,Dba:SoCal Removal INSURER C: State Compensation Ins Fund(CA) 35076
<br /> 1640 E Edinger Ave,Unit C INSURER D:
<br /> INSURER E:
<br /> Santa Ana CA 92705 INSURER F:
<br /> COVERAGES CERTIFICATE NUMBER: CL255169238 REVISION NUMBER:
<br /> THIS IS TO CERTIFYTHAT 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 TYPE OF INSURANCE ADDL UBR POLICY NUMBER M�DD YYYYMLICY EFF O DD YYYY LIMITS
<br /> ICY EXP
<br /> LTR INSD WVD
<br /> X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000
<br /> DAMAGE_7CLAIMS-MADE �OCCUR PREM SESORENTE Ea occur ence $ 50,000
<br /> X Professional Liability MED EXP(Any one person) $ 5,000
<br /> A Y ENC000448505-25 05/01/2025 05/01/2026 PERSONAL&ADV INJURY $ 2,000,000
<br /> GEN'LAGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $ 4,000,000
<br /> X POLICY ❑ PRO ❑ 4,000,000
<br /> JECT LOC PRODUCTS-COMP/OPAGG $
<br /> OTHER: $
<br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 2,000,000
<br /> Ea accident
<br /> X ANYAUTO BODILY INJURY(Per person) $
<br /> B OWNED SCHEDULED 02264376 06/19/2025 12/19/2025 BODILY INJURY(Per accident) $
<br /> AUTOS ONLY AUTOS
<br /> X HIRED �/ NON-OWNED PROPERTY DAMAGE $
<br /> AUTOS ONLY /� AUTOS ONLY Per accident
<br /> UMBRELLA LIAB OCCUR EACH OCCURRENCE $
<br /> EXCESS LIAB CLAIMS-MADE AGGREGATE $
<br /> DED RETENTION$ $
<br /> WORKERS COMPENSATION X S PER
<br /> TATUTE ER 1,000,000
<br /> AND EMPLOYERS'LIABILITY Y/N 1,000,000
<br /> ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $
<br /> C OFFICER/MEMBER EXCLUDED? ❑ NIA 9131135 05/01/2025 05/01/2026
<br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000
<br /> If yes,describe under 1,000,000
<br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $
<br /> Pollution Each Occurrence $2,000,000
<br /> A Professional Liability ENC000448505-25 05/01/2025 05/01/2026 General Aggregate $4,000,000
<br /> DESCRIPTION OF OPERATIONS/LOCATIONS/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 /> Tu Tran Digitally signed by
<br /> Tu Tran Nguyen
<br /> Nguyen°6a3;zo APPROVED
<br /> By Tu Tran Nguyen at 4:06 pm,Jul 08,2025
<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 /> AUTHORIZED REPRESENTATIVE
<br /> Sant I
<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
<br />
|