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STETENG-01 RBUCK
<br /> CERTIFICATE OF LIABILITY INSURANCE DATE(M
<br /> 5/23/2DIYYYY)
<br /> 025
<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 License#OD01900 CONTACT Rhonda Buck
<br /> NAME:
<br /> GDI Insurance Agency,Inc. PHONE Fax
<br /> 801 Geer Road (A/C,No,Ext):(888)420-1967 (A/C,No):
<br /> Turlock,CA 95380 E-MAIL .Rhonda.Buck@gdiins.com
<br /> ADDRESS
<br /> INSURERS AFFORDING COVERAGE NAIC#
<br /> INSURER A:The Hanover Insurance Group 002225
<br /> INSURED INSURER B:The Hanover American Insurance Company 136064
<br /> Stetson Engineers,Inc. INSURER C:U.S.Specialty Insurance Co 29599
<br /> 2171 E.Francisco Blvd,Ste.K INSURER D:
<br /> San Rafael,CA 94901
<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 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 TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS
<br /> LTRD D M DD
<br /> A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
<br /> CLAIMS-MADE OCCUR X X OZFD955322 71112024 7/1/2025 DAMAGE
<br /> PREMISES Ea occurrence $ 300,000
<br /> X see other cov MED EXP(Any oneperson) $ 10,000
<br /> PERSONAL&ADV INJURY $ 1,000,000
<br /> GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000
<br /> X POLICY PECOT- LOC PRODUCTS-COMPIOPAGG $ 2,000,000
<br /> OTHER: $
<br /> A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000
<br /> Ea accident $
<br /> X ANY AUTO X X AWFD955306 7/1/2024 7/1/2025 BODILY INJURY Per person) $
<br /> OWNED SCHEDULED
<br /> AUTOS ONLY AUTOS BODILY INJURY Per accident S
<br /> X HIRED X NON-OWNED PROPERTY DAMAGE
<br /> AUTOS ONLY AUTOS ONLY Per accident $
<br /> A UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 3,000,000
<br /> X EXCESS LIAB CLAIMS-MADE OZFD955322 7/1/2024 7/1/2025 AGGREGATE $ 3,000,000
<br /> DED X RETENTION$ 0
<br /> B WORKERS COMPENSATION X PER OTH-
<br /> AND EMPLOYERS'LIABILITY Y/N ER
<br /> ANY PROPRIETOR/PARTNERIEXECUTIVE X WZFD928932 7/1/2024 7/1/2025 1,000,000
<br /> FFICERIMEMBER EXCLUDE N/A E.L.EACH ACCIDENT $
<br /> Man D?datory in NH) E.L.DISEASE-EA EMPLOYE $ 1,000,000
<br /> If yes,describe under 1,000,000
<br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $
<br /> C Professional Liab X US2434831 711/2024 7/1/2025 see remarks
<br /> I
<br /> DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Digitally signed b
<br /> SEE ATTACHED ADDENDUM. 30 day notice of cancellation except 10 days when for nonpayment of premium. RE:N-2021-097 Tu Tran Tu Tran Nguyen
<br /> Certificate Holder Note:City of Santa Ana its officers,employees,agents and representatives are Date:2025.05.27
<br /> additional insured with primary coverage and waiver of subrogation as Nguyen 07:58:08-07'00'
<br /> required by written contract with respect to operations of the named
<br /> insured per form 3911006, 3911003,4610478&4610155 attached.
<br /> Waiver of subrogation per attached WC040306. APPROVED
<br /> By Tu Tran Nguyen at 7:57 am,May 27,2025
<br /> CERTIFICATE HOLDER CANCELLATION
<br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> City of Santa Ana THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br /> y ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> Water Resources Division
<br /> 220 S Daisy Ave
<br /> Santa Ana,CA 92703 AUTHORIZED REPRESENTATIVE
<br /> C"
<br /> ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved.
<br /> The ACORD name and logo are registered marks of ACORD
<br />
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