|
i
<br /> CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY)
<br /> 10/27/2025
<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(les)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 /> Numberl Insurance Marketing Services NAME: Shannon Balo
<br /> 17111 Beach Blvd Ste 103 PHONE Ex (714848-4400 me No: (714)848.3500
<br /> Huntington Beach, CA 92647 ADDRESS: Shannon@numberlins.com
<br /> License#: OC17917 INSURERS AFFORDING COVERAGE NAIC M
<br /> INSURERA: Kinsale Insurance Company
<br /> INSURED INSURERB: California Automobile Ins 38342
<br /> A 2 Z CONSTRUCT INC INSURER : Nautilus Insurance Company
<br /> 63 VIA GATILLO INSURERD: National Liability&Flre In urance Company
<br /> RANCHO SANTA MARGAR,CA 92688-3160 INSURER E: Colony Insurance..Compan
<br /> INSURER P
<br /> COVERAGES CERTIFICATE NUMBER: 00004613-2078684 REVISION NUMBER: 42
<br /> THIS 15 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 POLICY EFF POLICY EXP
<br /> ADDL5UBR
<br /> LTR TYPE OF INSURANCE POLICY NUMBER MMIDDIYYYY MMIDDIYYYY LIMITS
<br /> A X COMMERCIAL GENERAL LIABILITY Y Y 0100318627-1 08116/2025 08/16/2026 EACH OCCURRENCE $ 11000,000
<br /> D E T RENT
<br /> CLAIMS-MADE X OCCUR PREMISES Ea currence $ 100 000
<br /> MEDEXP(Any one person $ Excluded
<br /> PERSONAL&ADV INJURY $ 11000,000
<br /> ,
<br /> GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000
<br /> )( POLICY❑jE� LOC
<br /> PRODUCTS-COMPIOPAGG $ 2,000,000
<br /> OTHER: $
<br /> B AUTOMOBILE LIABILITY TO-MRIY Y BA040000086557 02/15/2025 02/1512026 EaaaacldenSINGLELIMIT $ 1,000,000
<br /> ANY AUTO BODILY INJURY(Per person) $
<br /> OWNED SCHEDULED
<br /> HIRED NON-OWNED
<br /> AUTOS ONLY Ix
<br /> AUTOS 130DILY INJURY(Per accident) $
<br /> XAUTOS ONLY AUTOS ONLY PROPERTY DAMAGE $
<br /> Per
<br /> accident
<br /> C UMBRELLA LIAB X OCCUR AN358502 0811612025 0811612026 EACH OCCURRENCE $ 4,000,000
<br /> X EXCESS LIAB CLAIMS�MADE AGGREGATE $ 4,000,000
<br /> ❑ED RETENTION$ $
<br /> D AND EMPLOYERS'
<br /> YERS'LIABILITY
<br /> IONILIT Y A9WC580764 12/26/2024 12126/2025 X PER OER"
<br /> AND EMPLOYERS'LIABILITY Y f N STATUTE ER
<br /> ANY PROPRIETORIPARTNERIEXECUTIVE E.L.EACHACCIDFNT $ 1,000,000
<br /> OFFICERIMEMBER EXCLUDED? � N I A
<br /> (Mandatory In NH) E.L.DISEASE-FA EMPLOYEE $ 1,000,000
<br /> If yes,describe under
<br /> D ESC RIPTION OF OPERATIONS below E.L.DISEASE POLICY LIMIT $ 1,000,000
<br /> E Pollution CSP4245644 07/1012025 0711012026 General Aggregate 2,000,000
<br /> DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space is required)
<br /> City of Santa Ana, its City Council, officers, officials,employees, agents,and volunteers are named additional insured with
<br /> regards to CGL and commercial Auto per policy when required by written contract with the insured.Primary and non
<br /> contributory wording shall be afforded by the policy to the additional insured.Waiver of subrogation shall be afforded by the
<br /> CGL,commercial Auto and WC policy in favor of the additional insured.
<br /> APPROVED
<br /> 8y Tu Tran.Nguyen at 2.33:prn,Oct'27,2026
<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 /> Attention: Public Works Agency, M-92 ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> 220 S. Daisy Ave. Building A AUTH ZED REPRESS TATIV
<br /> SANTA ANA, CA 92703
<br /> 5SB
<br /> @ 1988.2015 ACORD CORPORATION. All rights reserved.
<br /> ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD Printed by SSB on 10/2712025 at 02:18PM
<br />
|