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7 ® GATE(MMIDDIYYYY) <br /> A <br /> VlC?^® CERTIFICATE OF LIABILITY INSURANCE 6/2/2025 <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 CONTNAME:ACT Lisa Shimizu-Fookes <br /> AssuredPartners Design Professionals Insurance Services, LLC PHONE 714-427-3482 FAX.No): <br /> 3697 Mt. Diablo Blvd Suite 230 (AIC No F.xty <br /> Lafayette CA 94549 ADDRESS: CertsDesignPro@AssuredPartners.com <br /> INSURER(S)AFFORDING COVERAGE NAIL# <br /> License#:6003745 INSURER A:XL Specialty Insurance CO. 37885 <br /> INSURED PSOMAS0.01 INSURER B: <br /> PSOMAS <br /> 865 S. Figueroa Street, Suite 3200 INSURER C: <br /> Los Angeles CA 90017 INSURER D: <br /> INSURER E: <br /> ' INSURER F: <br /> COVERAGES CERTIFICATE NUMBER:1392840291 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 FIEREIN IS SUBJECT TO ALL THE TERMS, <br /> EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br /> ADDL SUBR POLICY EFF POLICY EXP <br /> ILTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD/YYYY) IMMIDD/YYYY) LIMITS <br /> COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ <br /> DAMAGE TO RENTED <br /> CLAIMS-MADE OCCUR PREMISES(Ea occurrence) $ <br /> MED EXP(Any one person) $ <br /> PERSONAL&ADV INJURY $ <br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ <br /> POLICY PRO—[ LOC <br /> ECT PRODUCTS-COMP/OP AGG $ <br /> OTHER: $ <br /> COMBINED SINGLE LIMIT $ <br /> AUTOMOBILE LIABILITY (Ea accident) <br /> ANY AUTO BODILY INJURY(Per person) $ <br /> OWNED; SCHEDULED BODILY INJURY(Per accident) $ <br /> AUTOS ONLY AUTOS <br /> HIRED NON-OWNED PROPERTY DAMAGE $ <br /> AUTOS ONLY AUTOS ONLY (Per accident) <br /> $ <br /> UMBRELLA LIAB OCCUR EACH OCCURRENCE $ <br /> EXCESS LIAB CLAIMS-MADE AGGREGATE $ <br /> DED RETENTION$ _ $ <br /> WORKERS COMPENSATION PSTA UTE ERH <br /> AND EMPLOYERS'LIABILITY Y/N <br /> ANYPROPRIETOR/PARTNER/EXECUTIVE I NIA E.L.EACH ACCIDENT $ <br /> OFFICEWMEMBEREXCLUDEOP f <br /> (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ <br /> If yes,describe under E.L.DISEASE-POLICY LIMIT $ <br /> DESCRIPTION OF OPERATIONS below <br /> A Professional Llab&Poll.Liab Y DPR5033899 10/15/2024 10/15/2025 Per Claim $2,000,000 <br /> Claims-Made Form Aggregate Limit $2,000,000 <br /> Retro Date:10/15/1947 <br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) <br /> Additional Insured Status is not available on Professional Liability Policy. • <br /> 2SAN051400,ON-CALL ENGINEERING SERVICES(Contract#A-2022-158-3),Client Reference#A-2022-158-03 <br /> APPROVED <br /> By Ti'Trap Ngd!Yap 6t s%13 am._J.un. $_3925. <br /> CERTIFICATE HOLDER CANCELLATION 30 Day Notice of Cancellation <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 ACCORDANCE WITH THE POLICY PROVISIONS. <br /> Attn: Heidi Chou(M-85) <br /> 215 S. Center St. AUTHORIZED REPRESENTATIVE <br /> Santa Ana CA 92703 <br /> I <br /> ©1988-2015 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD <br />