|
AC"R©® CERTIFICATE OF LIABILITY INSURANCE FDATE(MMIDDfYYYY)
<br /> 8/6/2025
<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
<br /> NAME: Tod Pradels
<br /> NFP Prop& Casualty Sery Inc. PHONE FAX
<br /> No:858-436-2442
<br /> 363£ Nobel Drive Al N Ex 858-519-3235
<br /> Suite 340 E-MAIL ADDRESS: Tod.Pradels of .com
<br /> San Diego CA 92122 INSURERS AFFORDING COVERAGE NAIL#
<br /> License#,OF15715 INSURER A:Travelers Indemnity Company of Connecticut 25682
<br /> INSURED PACI€NT-03 INSURER B:Travelers Property Casualty Company of America 25674
<br /> Pacific International Electric Company, Inc.DBA: Pacific Industrial Electric INSURER C: Illinois Union Insurance Company 27960
<br /> 230 N. Orange Ave. INSURERD:Travelers Casualty and Surety Company 19038
<br /> Brea GA 92821
<br /> INSURER E
<br /> INSURER F:
<br /> COVERAGES CERTIFICATE NUMBER:839207755 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
<br /> LTR POLICYNUMBER MM0D!'yYYY (MMIDI LIMITS
<br /> A X COMMERCIAL GENERAL LIABILITY Y Y C09X36997A 7/1/2025 711/2026 EACH DAMAGE TO RENTED
<br /> OCCURRENCE $2,000,000
<br /> CLAIMS-MADE FxIOCCUR PREMISES Ea occurrence $300,000
<br /> I EXP(Any one person) $5,000
<br /> PERSONAL&ADV INJURY $2,000,000
<br /> GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000
<br /> POLICY FX PRO-
<br /> JECT 0 LOC PRODUCTS-COMP/OP AGG $2,000,flDD
<br /> OTHER: PI)Deductible $$2,500
<br /> B AUTOMOBILE LIABILITY Y Y 8109X370341 7/1/2025 7/112026 COMBINED SINGLE LIMIT Ea acci $1,OD0,000
<br /> dent
<br /> X ANY AUTO BODILY INJURY(Per person} $
<br /> OWNED SCHEDULED BODILY INJURY Per accident AUTOS ONLY AUTOS ( ) $
<br /> X HIRED X NON-OWNED PROPERTY DAMAGE
<br /> AUTOS ONLY AUTOS ONLY Per accident $
<br /> B X UMBRELLA LIAB X OCCUR CUP9X373620 711/2025 7/1/2026 EACH OCCURRENCE $10,ODD,Ofl6
<br /> EXCESS ICLAIMS-MADE
<br /> AGGREGATE $10,000,a00
<br /> DED X I RETENTION$1 ri nnn $
<br /> B WORKERS COMPENSATION Y UB9X370943 7/112025 7/1/2026 X STATUTE ERRH-
<br /> AND EMPLOYERS'LIABILITY Y I N
<br /> ANYPROPRIETORIPARTNEH!EXECUTIVE N E.L.EACH ACC€UENT
<br /> OFFICER/MEMBER EXCLUDED? ❑ N1A $1,000,000
<br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000,000
<br /> It yes,describe under
<br /> UESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000
<br /> C Pollution Liability CEO G47411968 003 7/112025 7/1/2026 Retention-S5,004 3,000,000
<br /> C E&O/Professional Liab. Y CEO G47411968 003 71112025 7/112026 Retention-S15,000 3,000,ap0
<br /> ❑ Cr melEmpkcyee Theft 107112041 711/2025 7/1/2026 Retention-S10.000 2,001
<br /> DESCRIPTION OF OPERATIONS)LOCATIONS/VEHICLES {ACORD 101,Additional Remarks Schedule,may be attached it more space is required)
<br /> Pollution Liability Policy#CEO G47411968 003
<br /> CONTRACTORS EMERGENCY RESPONSE AND CATASTROPHE MANAGEMENT COVERAGE(Coverage C.)included in Aggregate 1 Retention$25,000
<br /> Per Pollution Condition or Site Environmental Condition
<br /> Re:Job#250703,City of Santa Ana,Attention:Public Works Agency—Jose Medina 220 S. Daisy Avenue, M-85 Santa Ana,CA 92703.
<br /> City of Santa Ana, its City Council,officers,officials,employees,agents,and volunteers are included as additional insured with respects to general ad
<br /> Automobile Liability.Waiver of subrogation in Favour of the certificate holder with respects to General Liability,Automobile Liability,Workers Compensation and
<br /> Professional liability as required by written contract.
<br /> CERTIFICATE HOLDER APPROVEDCANCELLATION
<br /> OyTu Tran Aiguyen of 12:20Fm,Aug06.2025 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 Attention: Public Works Agency--Jose ACCORDANCE WITH THE POLICY PROVISIONS,
<br /> Medina
<br /> 220 S. Daisy Avenue, M-85 AUTHORIZED REPRESENTATIVE
<br /> Santa Ana CA 92703 Tu Tran Digiully signed by
<br /> r„TM1ng„rea °7 �
<br /> na,p;2cY25,ue.Ofi
<br /> O 1988-2015 ACORD CORPORATION. All rights reserved.
<br /> ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD
<br />
|