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AC R CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY)
<br /> 09/3012025
<br /> THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLYAND 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 UUNTACT mktd€r
<br /> NAME:
<br /> CAL-KOR Insurance Services PHONE (213)387-5000 F
<br /> A C No Ext Alc,No (213)388-8695
<br /> 3255 Wilshire Blvd E-MAIL
<br /> ADDRESS:
<br /> Ste 1500 INSURERS)AFFORDING COVERAGE
<br /> NAIC#
<br /> Los Angeles CA 90010 INSURERA: Gemini Insurance Company 10833
<br /> INSURED
<br /> INSURER B: Kem er
<br /> P Auto Commerical 38156
<br /> Loengreen Inc. INSURER C: Scottsdale Insurance Company 41297
<br /> 2837 James M Wood Blvd INSURER D: SCIF 35076
<br /> INSURER E: The Ohio Casualty Insurance Company
<br /> LOSAngeleS CA 90006 INSURERF:
<br /> COVERAGES CERTIFICATE NUMBER: CL2512156591 REVISION NUMBER:
<br /> THIS IS TO CE.RTIFYTHAT 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 POLICY EFF POLICY EXP
<br /> LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MMlDDlYYYY MMlDDlYYYY LIMITS
<br /> X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
<br /> CLAIMS-MADE N OCCUR PREMISES Ea occurrence $ 50,000
<br /> MED EXP Any one person) $ 5,000
<br /> A Y Y VCGPD33343 01/14/2025 01/14/2026 PERSONAL&ADV INJURY $ 1,000,000
<br /> GEN'LAGGREGATELIMITAPPLIESPER: GENERAL AGGREGATE $ 2.000,000
<br /> X POLICY❑J�CT LOC PRODUCTS-COMPIOPAGG $ 2,000,000
<br /> OTHER: $
<br /> AUTOMOBILE LIABILITY EO BINElds�DitSINGLELIMIT $ 1,000,000
<br /> ANYAUTO BODILY INJURY(Per person) $
<br /> B OWNED 1xx
<br /> SCHEDULED Y Y 50007861301 09h1/2025 03/11/2026 BODILYINJURY(Peraccident) $
<br /> AUTOS ONLY AUTOS
<br /> X HIRED NON-OWNED PROPERTY DAMAGEAUTOS ONLY AUTOS ONLY Per accident $
<br /> X UMBRELLALIAB X OCCUR $ 5,000,000
<br /> EACH OCCURRENCE
<br /> C EXCESS LIAB CLAIMS-MADE Y Y CXS4042019 01/14/2025 01/14/2026 AGGREGATE $ 5,000,000
<br /> DED I X RETENTION$ 25,000 $
<br /> WORKERS COMPENSATION X1
<br /> STER ATUTE EORH
<br /> AND EMPLOYERS'LIABILITY YI N
<br /> D ANY PROPRIETORIPARTNERIEXECUTIVE N/A Y 92441452025 01I1212025 01/12/2026 E.L.EACH ACCIDENT $ 1,000,000
<br /> OFFICEWMEMBER EXCLUDED?
<br /> (Mandatory 1n NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000
<br /> If yes,describe under
<br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE•POLICY LIMIT $ 1,000,000
<br /> Builder's Risk Cost of construction $1,150,000
<br /> E BM069570673 09/01/2025 09/01/2020 Soft Cost $400,000
<br /> DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more apace Is required)
<br /> *10-day notice for non-payment of premium. City of Santa Ana,its City Council,officers,officials,employees,agents,and volunteers are named as additional insured.
<br /> Tu Tran DigltalIy signed by
<br /> 7u Tran Nguyen
<br /> Date.20
<br /> Nguyen 0B3119?OT00',
<br /> APPROVED
<br /> CERTIFICATE HOLDER CANCELLATION Hy 1 u Fran Nguyen et&:30 am;Oct 27 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 ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> PWA-PFFR
<br /> 20 Civic enter Piz,M-11 AUTHORIZED REPRESENTATIVE
<br /> Santa Ana CA 92701
<br /> ©1988.2015 ACORD CORPORATION. All rights roserved.
<br /> ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD
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