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DATE(MM/DD/YYYY) <br /> A�" CERTIFICATE OF LIABILITY INSURANCE <br /> 09/17/2025 <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 CONTACT Michael Rubin <br /> NAME: <br /> Rubin Insurance Agency PHONE (858)457-5720 FAx <br /> A/C No Ext: A/C,No): <br /> 5075 Shoreham Place Suite 100 E-MAIL michael@rubininsurance.com <br /> ADDRESS: <br /> INSURER(S)AFFORDING COVERAGE NAIC# <br /> San Diego CA 92122 INSURERA: Upland Specialty Insurance Company 16988 <br /> INSURED INSURER B: Insurance Company of the West 27847 <br /> Standard Enterprises Inc dba To and Mo Towing INSURER C: Trisura Specialty Insurance Company 16188 <br /> 518 N Poinsettia St INSURER D: <br /> INSURER E: <br /> Santa Ana CA 92701 INSURER F: <br /> COVERAGES CERTIFICATE NUMBER: 25/26 MASTER 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 MAYBE 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 POLICY EFF POLICY EXP <br /> LTR INSD WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS <br /> X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 <br /> CLAIMS-MADE FX OCCUR PREM SDAMAGES Ea oNcurDrence $ 100'000 <br /> MED EXP(Any one person) $ 5,000 <br /> C Y 175 TTS CA 100022-02 06/01/2025 06/01/2026 PERSONAL&ADV INJURY $ 1,000,000 <br /> MOTHER <br /> LAGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $ 2,000,000 <br /> POLICY ❑ PRO ❑ LOC PRODUCTS-COMP/OPAGG $ 2,000,000 <br /> JECT: <br /> Deductible $ 0 <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 <br /> Ea accident <br /> ANYAUTO BODILY INJURY(Per person) $ <br /> C OWNED �/ SCHEDULED Y 175 TTS CA 100022-02 06/01/2025 06/01/2026 BODILY INJURY(Per accident) $ <br /> AUTOS ONLY /� AUTOS <br /> X HIRED �/ NON-OWNED PROPERTY DAMAGE $ <br /> AUTOS ONLY /� AUTOS ONLY Per accident <br /> UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 2,000,000 <br /> A X EXCESS LAB CLAIMS-MADE USXTL0988325 06/01/2025 06/01/2026 AGGREGATE $ 2,000,000 <br /> DED I X1 RETENTION $ 0 $ <br /> WORKERS COMPENSATION ER/� STATUTE EORH <br /> AND EMPLOYERS'LIABILITY Y/N 100000 <br /> O <br /> ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ <br /> B OFFICER/MEMBER EXCLUDED? ❑ N/A Y WVE 5020840 14 04/01/2025 04/01/2026 <br /> 00 <br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1000- <br /> If yes,describe under 1000000 <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ <br /> Garagekeepers Ded$500/2500 500,000 <br /> C On-Hook/Cargo 175 TTS CA 100022-02 06/01/2025 06/01/2026 Ded$2000 250,000 <br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) <br /> [Job#:CITY025 Job Type:] Digitally sign d <br /> Cityof Santa Ana,its officers,employees,a ents and representatives are named as additional insured with respects to general and auto liability of the Tu Tra n by Tu Tran <br /> 9 p p 9 Y Nguyen <br /> named insured,pursuant to written contract,agreement or memorandum of understanding.Coverage is primary and non-contributory.General liability Nguyen Date:202s.o.18 <br /> additional insured endorsement CG2026(1219)attached.Blanket general liability primary and non-contributory wording endorsement CG2001(1219) 1618:54-O 0' <br /> attached.Auto liability additional insured endorsement CA2048(1013)attached.Blanket workers compensation waiver of subrogation endorsement <br /> WC990634(0800)attached.*30 day notice of cancellation applies/10 day notice for non-payment. <br /> APPROVED <br /> CERTIFICATE HOLDER CANCELLATION I By Tu Tran Nguyen at 4:18 pm,Sep 18,2025 <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN <br /> City of Santa Ana Attn:Police Department-Traffic ACCORDANCE WITH THE POLICY PROVISIONS. <br /> 20 Civic Center Plaza <br /> AUTHORIZED REPRESENTATIVE�gA <br /> Santa Ana CA 92701 //�/�/I n <br /> @ 1988-201155 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD <br />