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<br /> C" CERTIFICATE OF LIABILITY INSURANCE 013119r2025
<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 endorsements.
<br /> PRODUCER CONTACT Gustavo A
<br /> NAME;
<br /> Business World Insurance Agency 9 Y PHONE (618)773-1100 FAx 619 773-1101
<br /> t-MAI�wFarJ): . __.,-_w.___ __� ..I V�,Nnk. ( )
<br /> 7$00 University Ave A-1 ADDRESS; iinsLlremefree:com -_
<br /> INSURER(S)AFFORDING COVERAGE.
<br /> La Mesa CA 91942 INSURER A: CUMtS SPECIALTY INS CO INC __ 12758
<br /> INSURED INSURER B: KEMPER AUTO
<br /> FIRST TRADE LLC dba YMC INSURER C. EVANSTON INS CO _ _ 35378
<br /> 188 Technology Dr INSURER D; CLEAR SPRING PROPERTY AND CASUALTY COI
<br /> INSURER E -
<br /> _.._--
<br /> Irvine CA 92618 INSURERF:
<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 CLAIM5.
<br /> INSR ADDL SUOR' _.......... — T..—
<br /> LLT.R TYPE OF INSURANCE POLICY NUMBER — POLICYEFF COI FCY EXP '--"
<br /> DdY LIMITS
<br /> ID YYYfY
<br /> X` COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
<br /> _•�CLAIMS-MADE OCCUR DAMAG TO R hITE D
<br /> PR k_Ia �a oocurr reL:.�_$ 54,000
<br /> M_ED EXP(Any on rson $ 6,000
<br /> A Y Y CSCU0103194 01124/2025 01/24/2026 PERSONAL&ADV INJURY $ 1.000,000
<br /> GEMI.AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000
<br /> X POLICY jr Po_ ❑ _—
<br /> GT LOC PRODUCTS-COMP/OP AOG $ 2,n00,000
<br /> OTHER, $ _.,._.
<br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000
<br /> E aguldn
<br /> X ANY AUTO 86DILY INJURY(Per person) $— m u
<br /> 6 XOWNED SCHEDULED
<br /> AUTOS
<br /> AUTOS ONLY AUTOS Y Y 60007630201 03/05/2025 09105/2025 BODILY INJURY(Per accident) $
<br /> f_O
<br /> _
<br /> X HIRED X NON-OWNED PtR DAMAGE $
<br /> _ AUTOS ONLY _ AUTOS ONLY !9SSIoillj__,- ^
<br /> UMBRELLA LIAR X OCCUR EACH OCCURRENCE .$ 4,000,000
<br /> G X EXCESS L.IAB CLAkMS;MAPE EZXS3187944 01/31/2025 01/24/2026 AGGREGATE $ 4,000,000
<br /> DED RETENTION$ $
<br /> WORKERS COMPENSATION PER OTH-
<br /> _ANDEMPLOYERS'LIABILITY YIN STATUTE 101 —_
<br /> ANY PROPRIETORIPARTNERIEXECUTIVE !.L.EACH ACCIDENT $ 1,000,000
<br /> D OFFICERIMEMBEREXCLUDED? NIA Y I: CWCO2918001 031OB12025 03106/2026 - ° - --
<br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000
<br /> f yes,descrEh"under -
<br /> - DESCRIPTION OF..9PERATIONS below _ E.L.DISEASE-POLICYlIMIT $ 1,000,000
<br /> Contractor's Pollution Liability EACH OCCURRENC) $1,000,000
<br /> E; CSCU0103194 01/24/2025 01/2412026 AGGREGATE LIMIT $1,000,000
<br /> DESCRIPTION OF OPERATIONS[LOCATIONS/VEHICLES (ACORD 101,Addlllonnl Remarks Schedule,may he attached II more space is requlred)
<br /> F-Employee Benefits Liability-POLICY#CSCU0103194 EFF;01/2412025-0112412026 LIMIT:$1,000,000 EACH OCCURENCE AND$1,000,000 AGGREGATE
<br /> LIMIT
<br /> PROJECT 25-9013 HOUSING AUTHORITY TENT IMPROVEMENT AND ADA RESTROOM RENOVATION
<br /> City of Santa Ana,its Clty Council,officers,officials,employees,agents,and volunteers are to be covered as additional insureds on Contractor's CGL and AL
<br /> policies with Respect to liability arising out of work operations performed by or on behalf of Contractor including materials,parts,and equipment furnished In
<br /> connection with such work or operations and automobiles owned,leased, hired,or borrowed by ar on behalf❑f Contractor.Additional insured status can be
<br /> -CIERTIFICATE HCLQER CANCELLATION-
<br /> City of Santa Ana I Public Works Agency-Parks,Fleet, SHOULD ANY or THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> Facilities&Refuse Services THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br /> 20 Civic Center Plaza M-11 Santa Ana,CA 92701 ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> AUTHORIZED REPRESENTATIVE
<br /> APPROVED
<br /> By-TuTran-Nguyen.at8:29 am,Aug-20 2Q2�.:
<br /> D 1988-2015 ACORD CORPORATION, All rights reserved.
<br /> ACORD 25(2016/03) PuT�Ta��^�' The ACORD name and logo are registered marks of ACORD
<br /> Y
<br /> f LL TrdEI �Nguyen
<br /> Nguyen 1'o25:,.2e
<br /> 00:30:27-07'W
<br />
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