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NATiDAT-01 X00PSARAVA
<br /> ACC.7R�" CERTIFICATE OF LIABILITY INSURANCE DATDYYYYY)
<br /> 2121/2 21I2025
<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(les)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 Marijo Thompson
<br /> AssuredPartners of New Jersey,LLC dba AssuredPartners of Northeastern PHONE FAX
<br /> PA (AIC,No EKI:l!570 277-143$
<br /> I l } (ArC,No):
<br /> 1130 Highway 316 n'DRIE :Marijo.Thompson@assuredpartners.com
<br /> Wilkes Barre,PA 18702 INSURERS AFFORDING COVERAGE NAIL p
<br /> INSURER A:Federal Insurance Company 20281
<br /> INSURED INSURER B:Starstone National Insurance Com an 25496
<br /> National Data&Surveying Services,Inc INSURERC:Crum&Forster Insurance Company 42471
<br /> 5967 W.3rd Street
<br /> Ste 206 INSURER D:Allied World Surplus Lines Insurance Com an 24319 _
<br /> Los Angeles,CA 90036 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 /> INSR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS
<br /> LTR IN SD WVD
<br /> A X COMMERCIAL GENERALLIABILITY EACH OCCURRENCE S 1,000,000
<br /> CLAIMS-MADE X OCCUR X X 36069778 12/1/2024 12/112025 DAMAGETOPREMISESEaRENTEDoccurrence $ 1,000,000
<br /> MED EXP(Any one pevson $ 10,000
<br /> PERSONAL&ADV INJURY $ 1,000,000
<br /> GEN'LAGGREGATE LIMIT APPLIES PER, GENERAL AGGREGATE $ 2,000,000
<br /> X POLICY� PRO- LOC PRODUCTS-COMPIOPAGG $ 2,000,000
<br /> OTHER: EBLI AGGREGATE $ 1,000,000
<br /> A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000
<br /> Ea accident) $
<br /> X ANY AUTO X X 73624017 1211/2024 /211/2025 BODILYINJURY Perperson) $
<br /> OWNED SCHEDULED
<br /> AUTOS ONLY AUTOS BODILY INJURY Per accident) $
<br /> HIRED NON-AWNED PROPERTY DAMAGE
<br /> AUTOS ONLY AUTOS ONLY Per accident $
<br /> B X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 2,000,000
<br /> EXCESS LIAB CLAIMS-MADE X X CSX00067891 P-03 12/1/2024 121112025 AGGREGATE $. 2,000,000
<br /> DIED X I RETENTION$ fl $
<br /> WORKERS COMPENSATION
<br /> PER OTH-
<br /> AND EMPLOYERS'LIABILITY YIN STATUTE ER
<br /> ANY PROPRIETORIPARTNEWIEXECUTIVE F7 E_L,EACH ACCIDENT $
<br /> FFICERIMEMBFR EXCLUDE N f A
<br /> Mandatory In NH) D? EL DISEASE-EA EMPLOYE $
<br /> If yes,describe under
<br /> DESCRIPTION OF OPERATIONS below E-L.DISEASE-POLICY LIMIT $
<br /> C Excess Umbrella SEO-133533 121//2024 121112025 Aggregate 3,000,000
<br /> D Professional Liabili X X 0313-2802 12/1/2024 121112025 Each Occurrence/Aggr 2,000,000
<br /> DESCRIPTION OF OPERATIONS 1 LOCATIONS f VEHICLES {ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
<br /> When required by written contract:City of Santa Ana Its City Council,its officers,officials,employees,agents,and volunteers are included as additional
<br /> insured with regard to General Liability on a primary and non-contributory basis per form 80-02-2367;Additional insured with regard to Auto Liability per form
<br /> 16-02-0292.Waiver of subrogation applies with regard to General Liability per form 80-02-2000;with regard to Auto Liability per form 16-02-0292.$2million
<br /> Excess layer is follow form per form SSS EXS 0001 CW 03 21.30 day notice of cancellation applies.Additional insured and Waiver of subrogation applies with
<br /> regard to Professional Liability.
<br /> ogitziry sigre�
<br /> Tu Tran by TUTran
<br /> Nguyen D9arte:y2ozs.a7,g3 APPROVED
<br /> D
<br /> 09.39:30-08'0
<br /> CERTIFICATE HOLDER CANCELLATIOBy Tu Tran Nguyen at 9:38 am, Mar 03, 2025
<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 /> ty ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> 20 Civic Center Plaza,M-43
<br /> Santa Ana,CA 92701
<br /> AUTHORIZED/REPRESENTATIVE
<br /> ACORD 25(2016103) J ©!198E-2015 ACORD CORPORATION. All rights reserved.
<br /> The ACORD name and logo are registered marks of ACORD
<br />
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