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Client#: 1545435 ORRICHER
<br /> DATE(MM/DD/YYYY)
<br /> ACORDT,, CERTIFICATE OF LIABILITY INSURANCE 1 6/02/2025
<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 any rights to the certificate holder in lieu of such endorsement(s).
<br /> PRODUCER NAMEACT Avonni McCreary
<br /> USI Insurance Services, LLC PHONE 628 201-9001 FAX
<br /> AIC,No,Ext: A/C,No):
<br /> Lic#OG11911 E-MAIL ADDRESS: ry@ avonni.mccrea usi.com
<br /> 575 Market Street, Suite 3750 INSURER(S)AFFORDING COVERAGE NAIC#
<br /> San Francisco, CA 94105 INSURER A:Great Northern Insurance Company 20303
<br /> INSURED INSURER B:Federal Insurance Company 20281
<br /> BLX Group LLC
<br /> INSURER C
<br /> 355 South Grand Avenue, Suite 2700
<br /> INSURER D
<br /> Los Angeles, CA 90071
<br /> INSURER E
<br /> INSURER F:
<br /> COVERAGES CERTIFICATE NUMBER: 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 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 /> ILTR TYPE OF INSURANCE NSR WVD POLICY NUMBER ADDLSUBR POLICY EFF POLICY EXP LIMITS
<br /> (MM/DD/YYYY) (MM/DD/YYYY)
<br /> A X COMMERCIAL GENERAL LIABILITY 35821151 6/01/2025 06/01/2026 EACH OCCURRENCE $1,000,000
<br /> CLAIMS-MADE OCCUR PREMISES(E RENT
<br /> ur°nce) $1,000,000
<br /> X Host Liquor Included MED EXP(Any one person) S10,000
<br /> X Ind.Contractors PERSONAL&ADV INJURY $1,000,000
<br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000
<br /> X POLICY JRO-
<br /> ECT LOC PRODUCTS-COMP/OPAGG $2,000,000
<br /> OTHER: $
<br /> B AUTOMOBILE LIABILITY 74996569 6/01/2025 06/01/202 COEaMBINED accidentS INGLE LIMIT $1,000,000
<br /> ANY AUTO BODILY INJURY(Per person) $
<br /> OWNED SCHEDULED BODILY INJURY(Per accident) $
<br /> AUTOS ONLY AUTOS
<br /> HIRED NON-OWNED PROPERTY DAMAGE
<br /> X AUTOS ONLY FX
<br /> AUTOS ONLY Per accident $
<br /> B X UMBRELLA LIAB X OCCUR 79820023 6/01/2025 06/01/2026 EACH OCCURRENCE $5 OOO 000
<br /> EXCESS LIAB CLAIMS-MADE AGGREGATE s5,000,000
<br /> DED I X RETENTION$O $
<br /> WORKERS COMPENSATION PER OTH-
<br /> AND EMPLOYERS'LIABILITY Y/N STATUTE ER
<br /> ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $
<br /> OFFICER/MEMBER 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 /> TM Tran DigT.it N9 by
<br /> D.,1211111 APPROVED
<br /> Nguyen]1mno By Tu Tran Nguyen at 11:03 am,Jun 10, 2025
<br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is r
<br /> RE: Agreement N-2025-107,Agreement with BLX Group LLC for Provision of Arbitrage Rebate Compliance
<br /> Services
<br /> City of Santa Ana,officers, agents, employees, and volunteers are named as additional insured as relates
<br /> to general liability and auto liability in accordance with the terms and condition of the policies.The
<br /> general liability policy is primary and non-contributory when required by written contract. Certificate
<br /> (See Attached Descriptions)
<br /> CERTIFICATE HOLDER CANCELLATION
<br /> City of Santa Ana SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> y THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br /> Risk Management Division ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> 20 Civic Center Plaza,4th floor
<br /> Santa Ana, CA 92701 AUTHORIZED REPRESENTATIVE
<br /> " ©1588-2015 ACORD CORPORATION.All rights reserved.
<br /> ACORD 25(2016/03) 1 of 2 The ACORD name and logo are registered marks of ACORD
<br /> #S49487713/M49478772 M LKZP
<br />
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