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ACCOR" / 9/2025
<br /> YYYY)
<br /> ® CERTIFICATE OF LIABILITY INSURANCE 708
<br /> ( 29/2
<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 /> NAME: Doreen Adelman
<br /> Aon Private Risk Mgmt - Phoenix PHONE FAX
<br /> 2555 E Camelback Rd A/C No Ent: (951) 772-8720 (A/C,No):
<br /> E-MAIL
<br /> ADDRESS: doreen.adelman@aon.com
<br /> Phoenix AZ 85016
<br /> INSURER(S)AFFORDING COVERAGE NAIC#
<br /> INSURERA: Travelers Casualty Insurance Co 19046
<br /> INSURED INSURER B: Travelers Property Casualty Co 25674
<br /> Robert D. Niehaus, Inc
<br /> INSURER C: Ins Co of the State of PA/AIG 19429
<br /> 140 E. Carrillo Street INSURERD: Houston Casualty Company 42374
<br /> Santa Barbara CA 93101 INSURER E: Scottsdale Indemnity Company 15580
<br /> INSURER F: Continental Casualty Company 20443
<br /> COVERAGES zS CERTIFICATE NUMBER:Cert ID 51792 (72) 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 EFF POLICY EXP LIMITS
<br /> LTR INSD WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY
<br /> A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000
<br /> CLAIMS-MADE IX I OCCUR Y Y 680-OX748952-25-42 09/01/2025 09/01/2026 IREMSESOEaoccurrDence $ 300,000
<br /> MED EXP(Any one person) $ 51000
<br /> PERSONAL&ADV INJURY $ 2,000,000
<br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 4,000,000
<br /> POLICY❑ PRO ❑
<br /> JECT LOC PRODUCTS-COMP/OPAGG $ 4,000,000
<br /> X
<br /> OTHER: $
<br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $
<br /> Ea accident 1,000,000
<br /> p, ANY AUTO Y Y 680-OX748952-25-42 09/01/2025 09/01/2026 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 X AUTOS ONLY Per accident $
<br /> B UMBRELLA LAB X OCCUR Y Y CUP-OX751286-25-42 09/01/2025 09/01/2026 EACH OCCURRENCE $ 5,000,000
<br /> X EXCESS LIAB CLAIMS-MADE AGGREGATE $ 5,000,000
<br /> DED RETENTION$ $
<br /> WORKERS COMPENSATION PER OTH-
<br /> B AND EMPLOYERS'LIABILITY Y/N Y UB-OX750517-25-42-G 09/01/2025 09/01/2026 X STATUTE ER
<br /> ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000
<br /> OFFICER/MEMBER EXCLUDED? N/A
<br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 11000,000
<br /> If yes,describe under
<br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000
<br /> F EPLI 6052145186 09/01/2025 09/01/2026EPLI Aggregate Limit g 1,000,000
<br /> A Property - Commercial 680-OX748952-25-42 09/01/2025 09/01/2026Blanket Bus Per $ 865,886
<br /> Prop - Ded $1,000
<br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,maybe attached if more space is required)
<br /> Executive Director Public Works Agency, City of Santa Ana and, it's Officers, Officials, Employees, Digitallysigne
<br /> and volunteers are to be covered as Additional Insureds as respects all operations of the named Tu Tra n byTuTran
<br /> Insured per written contract on file. Includes Blanket Waiver of Subrogation and Blanket Primary Nguyen
<br /> en Date:2025.,0.3
<br /> Wording endorsement. Cancellation is 30 days except for non-payment which is 10 days. Excess Nguyo9s9a3-o��0�
<br /> follows the General Liability, Auto and Work Comp.
<br /> APPROVED
<br /> By Tu Tran Nguyen at 9:38 am,Oct 13,2025
<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 /> ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> City of Santa Ana
<br /> Attn: Water Resources Division (M-85)
<br /> 220 S. Daisy Avenue, Bldg A AUTHORIZED
<br /> Ra�REPRESENTATIVE
<br /> T�,
<br /> Ama
<br /> Santa Ana CA 92703 1g,
<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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