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AC"R" CERTIFICATE OF LIABILITY INSURANCE r
<br /> ATE(MMIDDIYYYY)
<br /> -�` 4/17/2025
<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
<br /> HUB International Insurance Services Inc. NAME: Debbie Williams
<br /> PO Box 255387 PH ONE ,916-480-4124 Fvc No:916-993-7224
<br /> Sacramento CA 95865 A Ri debbie.williams hubinternational.com
<br /> INSURERS AFFORDING COVERAGE NAIC#
<br /> License#:0757776 INSURERA:Nautilus Insurance Company 17370
<br /> INSURED INTEDEM-01 INSURERB:Key Risk Insurance Company 10885
<br /> Interior Demolition Inc
<br /> 23508 Pine Street INSURER C:State Compensation Insurance Fund of California 35076
<br /> Newhall CA 91321 INSURER D:
<br /> INSURER E:
<br /> INSURER F:
<br /> COVERAGES CERTIFICATE NUMBER:1026126484 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 ADDL SUER POLICY EFF POLICY EXP
<br /> LTR TYPE OF INSURANCE POLICY NUMBER MMIDDIYYYY) (MMIDD[YYYYI LIMITS
<br /> A X COMMERCIAL GENERAL LIABILITY Y Y ECP2035025-13 6/4/2024 614/2025 EACH OCCURRENCE S1,000,000
<br /> DAMAGE TO RENTED
<br /> CLAIMS-MADE X OCCUR PREMISES Ea occurrence $100,000
<br /> X $5,000 DedlOccur MED EXP(Any one person) $5,000
<br /> PERSONAL&ADV INJURY $1,000,000
<br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000
<br /> POLICY ]PE� LOC PRODUCTS-COMP/OP AGG $2,000,000
<br /> OTHER: $
<br /> B AUTOMOBILE LIABILITY Y Y BAP2035024-13 6/4/2024 6/4/2025 Ea aBl ideDt$INGLE LIMIT $1,000,000
<br /> X ANY AUTO BODILY INJURY(Per person) $
<br /> OWNED SCHEDULED BODILY INJURY P
<br /> AUTOS ONLY AUTOS (Per accident) $
<br /> HIRED NON-OWNED PROPERTY DAMAGE
<br /> AUTOS ONLY AUTOS ONLY Per accident $
<br /> A UMBRELLA LIAB X OCCUR FFX2035026-13 6/4/2024 6/4/2025 EACH OCCURRENCE $5,000,000
<br /> X EXCESS LIAB CLAIMS-MADE
<br /> AGGREGATE $5,000,000
<br /> DIED I X I RETENTION$n S
<br /> C WORKERS COMPENSATION Y 1977624-24 9/27l2024 9127/2025 X PER 01
<br /> AND EMPLOYERS'LIABILITY YIN STATUTE ER
<br /> ANYPROPRIETORIPARTNER/EXECUTIVE E.L.EACH ACCIDENT $1,000,000
<br /> OFFICERIMEMBER EXCLUDED? ❑ N/A
<br /> (Mandatory In Ni E.L.DISEASE-EA EMPLOYEE $1,000.000
<br /> If yes,describe under
<br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1.000.000
<br /> A Professional Liability ECP2035025-13 1 6/4/2025 Each Claim/Aggregate $1,000,000
<br /> Contractors Pollution Liability Each Occurrence/Agg. $1,000,000
<br /> DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) APPROVED
<br /> RE: 2520-City of Santa Ana-On Call Demo Services for Abatement Agreement By Tu Tran Nguyen at 2:f6 pm,Apr 18,2025
<br /> Additional Insured: City of Santa Ana,its officers,employees,agents and representatives are named as Additional Insureds with respect to General and Auto
<br /> Liability per the attached endorsements as required by written contract. Insurance is Primary and Non-Contributory. Waiver of Subrogation applies to Workers'
<br /> Compensation. Excess Liability extends over the Auto Liability,General Liability,Contractors Pollution Liability and Professional Liability. Policies provide for
<br /> 30 Days Notice of Cancellation,except 10 Days for Non-payment of Premium.
<br /> DigTu Tran To Tr an Ye by
<br /> Forms: 10217 0714,BENVCA06 0917,CA0444 1013,CA0449 1116,ECP1220 0121,ECP1246 0121,ECP1248 0121,ECP1259 0121 12025.04.1
<br /> Nguyen 14:17:24-0700
<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 ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> Attn: Rocio De Leon-Molina
<br /> Planning and Building Agency AUTHORIZED REPRESENTATIVE
<br /> 20 Civic Center Plaza
<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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