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OCEABLU-06 ADAVIS2
<br /> ,d►coRo CERTIFICATE OF LIABILITY INSURANCE FDATE(MM/DD/YYYY)
<br /> 10/9/2025
<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#0757776 CONTACT Alisha Davis
<br /> NAME:
<br /> HUB International Insurance Services Inc. PHONE FAX
<br /> 9855 Scranton Road (A/C,No,Ext):(877) 825-2681 No):(951)231-2572
<br /> Suite 100 E-MAIL-ADDRESS:alisha.davis@hubinternational.com
<br /> San Diego,CA 92121
<br /> INSURERS AFFORDING COVERAGE NAIC#
<br /> INSURER A:Westchester Surplus Lines Insurance Co. 10172
<br /> INSURED INSURER B:ACE Property&Casualty Insurance Company 20699
<br /> Ocean Blue Environmental Services,Inc. INSURER C:National Casualty Company 11991
<br /> 925 West Esther Street INSURER D:
<br /> Long Beach,CA 90813
<br /> 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 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 NUMBER POLICY EFF POLICY EXP LIMITS
<br /> LTR INSD WVD MM/DD/YYYY MM/DD/YYYY
<br /> A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
<br /> CLAIMS-MADE X OCCUR G47475843 002 7/1/2025 7/1/2026 DAMAGE TO RENTED 100,000
<br /> X X PREMISES Ea occurrence $
<br /> MED EXP(Any oneperson) $ 5,000
<br /> PERSONAL&ADV INJURY $ 1,000,000
<br /> GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000
<br /> X POLICY JECT1:1 LOC PRODUCTS-COMP/OP AGG $ 2,000,000
<br /> X OTHER:DED:$5,000
<br /> B AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000
<br /> Ea accident $
<br /> X ANY AUTO X X CAL H08886301 002 7/1/2025 7/1/2026 BODILY INJURY Perperson) $
<br /> OWNED SCHEDULED
<br /> AUTOS ONLY AUTOS BODILY INJURY Per accident $
<br /> HIRED NON-OWNED PROPERTY DAMAGE
<br /> AUTOS ONLY AUTOS ONLY Per accident)
<br /> ccident $
<br /> A UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 9,000,000
<br /> X EXCESS LIAB CLAIMS-MADE G47475855 002 7/1/2025 7/1/2026 AGGREGATE $ 9,000,000
<br /> DED RETENTION$ $
<br /> C WORKERS COMPENSATION X PER OTH-
<br /> AND EMPLOYERS'LIABILITY X STATUTE ER
<br /> WCC340082A 7/1/2025 7/1/2026 1,000,000
<br /> ANY PROPRIETOR/ R/EXECUTIVE N/A E.L.EACH ACCIDENT $
<br /> EXCLU
<br /> OFFICER/MEMBER EXCLUDED?
<br /> (Mandatory in NH) 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 $
<br /> A Pollution/Environm G47475843 002 7/1/2025 7/1/2026 [Aggregate
<br /> ach Occ/Aggregate 1,000,000
<br /> A Professional Liab G47475843 002 7/1/2025 7/1/2026 1,000,000
<br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
<br /> RE:Per Agreement#N-2025-253
<br /> City of Santa Ana,its City Council,its officers,officials,employees,agents,and volunteers are Additional Insured's with regards to the General Liability
<br /> policy
<br /> when required by a written contract,per the attached endorsement forms CG2010 04/13 and CG2037 04/13.Primary wording applies with regards to the
<br /> General Liability policy when required by a written contract,per the attached endorsement form ENV3252 1 211 8.Waiver of Subrogation applies with regards to
<br /> the General Liability policy when required by a written contract,per the attached endorsement form ENV3143 03/05.Additional Insured applies with regards to
<br /> the Auto Liability policy when required by a written contract,per the attached endorsement form BENVCA06 19/17.Waiver of Subrogation applies with
<br /> regards
<br /> CERTIFICATE HOLDER CANCELLATION
<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 /> Y ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> Attention:Santa Ana Police Department
<br /> 60 Civic Center Plaza TU Trdn Digitally signed by
<br /> Santa Ana,CA 92702 TuTranNguyen AUTHORIZED REPRESENTATIVE
<br /> Nguyen 08:21 307-07 00'9 4 �
<br /> A APPROVED ©1988-2015 ACORD CORPORATION. All rights reserved.
<br /> By Tu Tran Nguyen at 8:20 am, Oct 09, 2025 RD name and logo are registered marks of ACORD
<br />
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