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® DATE(MMlDD1YYYY)AC� <br /> CERTIFICATE OF LIABILITY INSURANCE 10/17/2025 <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($), 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 1S 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 endorsements. <br /> PRODUCER CONTACT <br /> NAME: Annette Romero <br /> Acrisure Southwest Partners Insurance Services, LLC PHONE g49 486 7904 aic No <br /> 611 Anton Blvd., Suite##1400 E-MAIL <br /> Costa Mesa, CA 92626 ADDRESS: aromero acrisure.00m <br /> INSURER(S)AFFORDING COVERAGE NAPOW <br /> www,patrisk.com OK07568 INSURERA: Valley Fore Insurance Company A+XV 20508 <br /> INSURED INSURERS: American Casualty Company of Reading,PA A+XV 20427 <br /> J &S Stripping, Inc. INSURERC: Continental Insurance Company A+XV 35289 <br /> 1544 S.1Xe and Avenue <br /> Ontario CA 91761 INSURER D: Insurance Company of the West A+XV 27847 <br /> INSURER E: <br /> INSURER F: <br /> COVERAGES CERTIFICATE NUMBER: 87687489 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 /> ILTRR TYPE OF INSURANCE ADDL SU n POLICPOLICY NUMBER MM DDY� POLICY <br /> LIMITS <br /> A ✓ COMMERCIAL GENERAL LIABILITY ✓ �/ 7018598845 3/29/2025 3/29/2026 EACH OCCURRENCE $1 000 000 <br /> DAMAGE TO <br /> CLAIMS-MADE OCCUR PREMISES(aENTED occurrrence $1 000 000 <br /> ✓ $10 000 Deductible MEO EXP(Any one person) $15 000 <br /> PERSONAL&ADV INJURY $1 000 000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 <br /> POLICY Z jEcT LOC PRODUCTS-COMPfOPAGG $2 00D 000 <br /> OTHER: $ <br /> B AUTOMOBILE LIABILITY ✓ ✓ 7018491424 3/29/2025 3/29/2026 Ee aBcld iD SINGLE LIMIT $1 000 000 <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 /> 1AUTOS ONLY AUTOS ONLY Per accident <br /> Uninsured motorist comt $1 000 000 <br /> C �/ UMBRELLALIAB OCCUR 7018491441 3/29/2025 3/29/2026 EACH OCCURRENCE $5 000 000 <br /> EXCESS LIAB CLAIMS-MADE AGGREGATE $5 000 000 <br /> DED I ✓I RETENTION$90,000 $ <br /> p WORKERS COMPENSATION ✓ WSD506490103 3/29/2025 3/29/2026 V srATUTE oTH <br /> AND EMPLOYERS'LIABILITY YIN <br /> OFF CEWMEMB REXCLUDED7ECUTIVE � NIA E.L.EACH ACCIDENT $1 O00 DOO <br /> (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $�0 <br /> If yes,describe under <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1 000 000 <br /> DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) <br /> Re:JSJN#4828-S/Roadway Sign and Striping Maintenance,Repair and Installation-Various Locations,Santa Ana,CA Digitally slgne <br /> CityuTran <br /> of Santa Ana,its City Council,its officers,officials,employees,a ents,and volunteers are named as Additional Insured as respects to Tr an n Nguyen <br /> Y9 p Nguyen <br /> General Liability&Auto Liability per endorsement attached where required by written contract.Coverage is Primary and Non-ContributoryNguyen Dafe:2025.1o. 7 <br /> and Waiver of Subrogation applies per endorsement attached.Excess/Umbrella follows form.Severability of interest applies. 15:05:16-07'D <br /> *30 days notice of cancellation, 10 days for non-payment of premium. <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 /> Attn:Arturo Rodriguez ACCORDANCE WITH THE POLICY PROVISIONS. <br /> 220 S Daisy Ave M-85 <br /> Santa Ana CA 92703 <br /> AUTHORITEb REPRE5£N7A71VE <br /> Dave Jacobson (� <br /> O 1988-2015 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD <br /> 87687//89 125�26 GL/AU/UMe/WC I Atnfette Romero 110/17/2025 1:15:31 PM (PDT) i Page 1 of 23 <br /> This certificate cane. s and supersedes ALL previously issued certificates. <br />