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DATE(MM/DD/YYYY)
<br /> A�" CERTIFICATE OF LIABILITY INSURANCE
<br /> 03/31/2026
<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 Brent Nishikawa
<br /> NAME:
<br /> The Liberty Company Insurance Brokers HCNNo Ext: (888)918-3960 (FAX
<br /> ,No
<br /> Lic#OD79653 E-MAIL bnishikawa@libertycompany.com
<br /> ADDRESS:
<br /> 5955 De Soto Ave,Ste 250 INSURER(S)AFFORDING COVERAGE NAIC#
<br /> Woodland Hills CA 91367 INSURERA: Travelers Property Casualty Co ofAmerica 25674
<br /> INSURED INSURER B: The Travelers Indemnity Co of CT 25682
<br /> 4Leaf,Inc. INSURERC: Berkshire Hathaway Homestate Insurance Company 20044
<br /> 2126 Rheem Dr INSURER D: Pacific Insurance Company,Limited 10046
<br /> INSURER E:
<br /> Pleasanton CA 94588 INSURER F:
<br /> COVERAGES CERTIFICATE NUMBER: 2026 NEW 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 TYPE OF INSURANCE POLICY EFF POLICY EXP
<br /> LTR INSD WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS
<br /> X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
<br /> CLAIMS-MADE FX OCCUR PREM SDAMAGES Ea oNcurDrence $ 1,000,000
<br /> MED EXP(Any one person) $ 5,000
<br /> A Y Y 6600519865A 03/15/2026 03/15/2027 PERSONAL&ADV INJURY $ 1,000,000
<br /> MOTHER
<br /> LAGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $ 2,000,000
<br /> POLICY PRO ❑ LOC PRODUCTS-COMP/OPAGG $ 2,000,000
<br /> JECT: $
<br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000
<br /> Ea accident
<br /> X ANYAUTO BODILY INJURY(Per person) $
<br /> B OWNED �/ SCHEDULED Y Y BA-C4831196-26-43-G 03/15/2026 03/15/2027 BODILY INJURY(Pe r accide nt) $
<br /> AUTOS ONLY /� AUTOS
<br /> X HIRED NON-OWNED PROPERTY DAMAGE $
<br /> AUTOS ONLY AUTOS ONLY Per accident
<br /> X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 6,000,000
<br /> A EXCESS LIAB CLAIMS-MADE CUPC4831922 03/15/2026 03/15/2027 AGGREGATE $ 6,000,000
<br /> DED I X1 RETENTION $ 0 $
<br /> WORKERS COMPENSATION X STATUTE EORH
<br /> AND EMPLOYERS'LIABI LI TY YIN 1,000,000
<br /> ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $
<br /> C OFFICER/MEMBER EXCLUDED? N/A Y FOWC726350 04/01/2026 04/01/2027
<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 /> Professional Liability Per Claim $5,000,000
<br /> D Retro Date:04/01/2007 Y 130HOS81505-26 03/15/2026 03/15/2027 Aggregate $5,000,000
<br /> Retention $50,000
<br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
<br /> RE:Agreement N-2025-278.
<br /> City of Santa Ana,its City Council,officers,officials,employees,agents,and volunteers are included as an Additional Insured under the Commercial
<br /> General Liability(Including completed operations)and Auto Liability on a Primary/Non-Contributory basis when required by written contract.A Waiver of
<br /> Subrogation in favor of the Additional Insured applies to the General Liability,Auto Liability,Workers Compensation and Professional Liability when required
<br /> by written contract.30 Notice of cancellation applies.
<br /> -4APPROVED
<br /> CERTIFICATE HOLDER CANCELLATION !Tu Tran Nguyen at 11:32 am,Apr 02,2026
<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 /> Planning and Building Agency
<br /> 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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