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HCISYST-01 E
<br /> '`+ram Rom® CERTIFICATE OF LIABILITY INSURANCE OATE(M
<br /> 7I241202YYYl
<br /> 2025
<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#OM70471 aCfflACT HCI Requests
<br /> Orlon Risk Management Insurance Services,An Alera Group Insurance ICD,"ni, Ac,Agency,LLC Aex (949)283-8850 Nop:(949)263-8860
<br /> uestsorlonrisk.com
<br /> 18575 Jamboree Rd,Suite 500 nllks :hclrequests@orlonrisk.com
<br /> Irvine,CA 92612 INSURERS AFFORDING COVERAGE NAIC#
<br /> INSURER A:Hudson Excess Insurance Company 14484
<br /> INSURED INSURER B:Federal Insurance Company 20281
<br /> HCI Systems,Inc. INSURER C:
<br /> 1219 E Elm Street INSURER D:
<br /> Ontario,CA 91761
<br /> INSURER E:
<br /> INSURER F;
<br /> COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
<br /> THIS 1S 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 A�INSDL SUBR WVD POLICY NUMBER POLICY EFF POLICY EXPITR LIMITS
<br /> A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE 1,00D,0DD
<br /> CLAIMS-MADE X OCCUR ALM 1017300 3/2/2025 31212026 DAMAGE TO RENTED 1 DD,ODO
<br /> X X RE Curren
<br /> MED EXP(Any one arson 5,000
<br /> PERSONAL&ADV INJURY 1,000,000
<br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE 2,000,000
<br /> POLICY®jE o LOC PRODUCTS-COMP/OP AGG 2,000,000
<br /> OTHER:$15,000 Deductible Professional Included
<br /> B COMBINED SINGLE LIMIT
<br /> AUTOMOBILE LIABILITY cci ant $ 1,00D,000
<br /> Ix
<br /> ANY AUTO X X 54309497 31212025 312/2026 BODILY INJURY Per erson $
<br /> OWNED SCHEDULED
<br /> AURTEO�S ONLY AUUTOpSW p BOODILY INJURY Per accident $
<br /> AUTOS ONLY X A<JTDS ONP Y Pe�accldent AMAGE $
<br /> A UMBRELLALIAB X OCCUR EACH OCCURRENCE $ 5,000,000
<br /> X EXCESS LIAB CLAIMS-MADE ALMU1007300 312/2025 31212026 AGGREGATE 5,000,000
<br /> DED I X I RETENTION$ 10,001) GL EL Only
<br /> B ANU EMPSOYER9�LIABIILITY YIN X STATUTE �RH
<br /> ANY PROPRIETORIPARTNERIEXECUTiVE 543D9498 3I212025 3/212026 1,000,000
<br /> �FFICERIMEMggEEREXCLUDE07 N!A E.LEACHACCIDENT
<br /> MandstoryInNH) 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 i
<br /> DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (AGORA 101.Additional Remarks Schedule,may be attached If more space Is required)
<br /> RE:City of Santa Ana-Fire Alarm&Sprinkler Systems Inspection,Repair and Maintenance agreement
<br /> City of Santa Ana,its City Council,its officers,officials,employees,agents,and volunteers are included as additional Insured(on a primary and
<br /> non-contributory basis)per the terms of the attached General Liability and Auto Liability endorsements.Waiver of subrogation applies per the terms of the
<br /> attached General Liability,Auto Liability,and Worker's Compensation endorsements.30 day notice of cancellation;10 day notice for non-payment of premium
<br /> applies per policy provisions.Excess Liability follows form over General Liability,Auto Liability,and Employer's Liability.
<br /> TU Tran Digitally signed byTu
<br /> Tran Nguyen -
<br /> N Date:2025A7.3o APPROVED_
<br /> I5;17:n
<br /> u en
<br /> 9 -aroo
<br /> CERTIFICATE HOLDER CANCELLATION By Tu Tran Nguyen at3.! pm JuL30 Ms
<br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> City of Santa Ana Public Works Agency THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br /> Y g y ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> Parks,Fleet,Facilities&Refuse Services
<br /> 20 Civic Center Plaza M-11
<br /> Santa Ana,CA 92701 AUTHORIZED_REPRESENTATIVE
<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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