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A Rai CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDNYYYI
<br /> 1 0/2 712 02 5
<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 pollcy(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 CONTACT
<br /> Numberl Insurance Marketing Services NAME: Shannon Belo
<br /> 17111 Beach Blvd Ste 103 PHONE E . (714)848-4400 Fa1c No): (714)648.3500
<br /> Huntington Beach, CA 92647 ADDRESS: Shannon@numberlins.com
<br /> License 9: OC17917 INSURERS AFFORDING COVERAGE NAIC N
<br /> INSURERA: Kinsale Insurance Company
<br /> INSURED INSURER5: California Automobile Ins 38342
<br /> A 2 z CONSTRUCT INC INSURER C: Nautilus Insurance Company
<br /> 63 VIA GATILLO INSURER D: National Liability&Fire Insurance Company
<br /> RANCHO SANTA MARGAR, CA 92688-3160 INSURER E: Colony Insurance Company
<br /> INSURER F:
<br /> COVERAGES CERTIFICATE NUMBER: 00004613-2078684 REVISION NUMBER: 42
<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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
<br /> CERTIFICATE MAYBE 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 I TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP
<br /> LTR POLICY NUMBER MMIDDIYYYY MMIDDIYYYY LIMITS
<br /> A X COMMERCIAL GENERAL LIABILITY Y Y 0100318627-1 08116/2025 08/16/2026 EACH OCCURRENCE $ 1,000,000
<br /> CLAIMS-MADE NJOCCUR DAMAGTED
<br /> PREMISES Ea occurrence $ 10,0000
<br /> MEDEXP(Any one person) $ Excluded
<br /> PERSONAL&ADV INJURY $ 1 DUD DDD
<br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000
<br /> X POLICY jE 0 LOC PRODUCTS-COMPIOP AGG $ 2,000,000
<br /> OTHER: $
<br /> B AUTOMOBILE LIABILITY Y Y BA040000086557 02/1512025 02/1512026 COMBINE
<br /> (Fa
<br /> acccidentslNGLE LIMIT $ 1,000,000
<br /> ANY AUTO BODILY INJURY(Par parson) $
<br /> OWNED SCHEDULED
<br /> AUTOS ONLY All745 BODILY INJURY( )
<br /> Per accident $
<br /> X
<br /> HIRED NON-OWNED PROPERTY DAMAGE $
<br /> X AUTOS ONLY X AUTOS ONLY per accident
<br /> `' UMBRELLA LIAR X OCCUR AN358502 08116/2025 0811612026 EACH OCCURRENCE $ 4,000,000
<br /> X EXCESS LIAR CLAIMS-MADE AGGREGATE $ 4,DD0,000
<br /> DIED I I RETENTION$ $
<br /> D WORKERS COMPENSATION Y 1 N Y A9WC580764 12/2612024 12/26/2025 X ER STATUTE OR"
<br /> AND EMPLOYERS'LIABILITY
<br /> ANY PROPRIETORIPARTHERIEXECUTIVE E,L.EACH ACCIDENT $ 1,DOO,000
<br /> OFPICFRIMEMBER EXCLUDED N/A
<br /> (Mandatory in NH) E.LDISEASE-EAEMPLOYE $ 1,000,000
<br /> If yes,describe under
<br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000 000
<br /> E Pollution CSP4245644 07/10/2025 07/10/2026 General Aggregate 2,000,000
<br /> DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES (ACORD IV,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 /> By Tv Tran Nguyen at 2.33 pm,Oc!27 2t72�-
<br /> _. ,.,-,
<br /> CERTIFICATE HOLDER CANCELLATION
<br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES HE 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
<br /> SANTA ANA, CA 92703 AUTH art ZED REPRESE TATIVE
<br /> sss
<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 10/27/2025 at 02:18PM
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