|
Atc" CERTIFICATE OF LIABILITY INSURANCE r
<br /> ATEIMMIDDIYYYY)
<br /> 11/13/2025
<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 /> PRooucER NAME cT Certificate Department
<br /> Cavignac PHONE Fax
<br /> 451 A Street, Suite 1840 No.
<br /> o Ex 619-744-0574 Arc No:619-234-8601
<br /> San Diego CA 92101 ADDRESS: certificates cavi nac-corn
<br /> INSURERS)AFFORDING COVERAGE NAIC 11
<br /> INSURER A:Travelers Property Casualty Company of America 25674
<br /> INSURED KTU&APL-01 INSURERB:Berkley Insurance Com an
<br /> KTU&A y32603
<br /> 3916 Normal Street INSURER C:Travelers Indemnity Co of Conn 25682
<br /> San Diego, CA 92103 INsURERD:Hartford Casualty Insurance Co 29424
<br /> INSURER E:
<br /> INSURER F:
<br /> COVERAGES CERTIFICATE NUMBER:109295591 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 /> ILTR TYPE OF INSURANCE AINSD AND DDL 5UBR POLICY EFF POLICY EXP
<br /> POLICY NUMBER MMIDDIYYYY) (MMIDDrdYWI LIMITS
<br /> A X COMMERCIALGENERALLIABILITY Y Y 6801H979452 9F112025 91112026 EACH OCCURRENCE $1,000,000
<br /> CLAIMS-MADE �OCCUR DAMAGE (Ea
<br /> PREMISESS Ea occurrence) $1,000,000
<br /> X Cross Liability MED EXP(An
<br /> y y one person)
<br /> ) $14,000
<br /> X Contractual Liah PERSONAL&ADV INJURY $1,000,000
<br /> GEN'L AGGREGATE LIMIT APPLIES PER;. GENERAL AGGREGATE $2,000,000
<br /> X POLICY I PEO 71 LOG
<br /> PRODUCTS-COMPlOP AG $2,000,000
<br /> OTHER' $
<br /> C. AUTOMOBILE LIABILITY Y Y BA2S035976 9/112025 9/112026 EOa aBINEDISINGLE LIMIT $1,000,000
<br /> ANY AUTO BODILY INJURY(Per person) $
<br /> OWNED SCHEDULED BODILY INJURY Per accident
<br /> AUTOS ONLY AUTOS I )
<br /> IXX
<br /> HiRED X NON-OWNED PROPERTY DAMAGE
<br /> AUTOS ONLY AUTOS ONLY Per accident $
<br /> NoOwnedAutcs $
<br /> UMBRELLA LIAR OCCUR EACH OCCURRENCE $.
<br /> EXCESS LIAB CLAIMS-MADE AGGREGATE $
<br /> DIED RETENTION$ $
<br /> p WORKERS COMPENSATION Y 72WEGGG6436 9/112025 911/2026 X SPER OT
<br /> TATUTE EERH
<br /> AND EMPLOYERS'LIABILITY Y 1 N
<br /> ANYPROPRIETORIPARTNEPJEXECUTIVE E.L.EACH ACCIDENT $1,000,000
<br /> OFFICER/MEMBER EXCLUDED? NIA
<br /> (Mandatary in NH) E.L.DISEASE-EA EMPLOYEE $1,000,000
<br /> If yes,describe under
<br /> DESCRIPTION OF OPERATIONS helm E.L.DISEASE-POLICY LIMIT $1,000,000
<br /> B Professional Liability Y AEC909023610 9/1/2025 91112026 Each Claim $5,000,000
<br /> Aggregate $5.000,000
<br /> DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached if more space is required)
<br /> Additional Insured coverage applies to General Liability and Automobile Liability for City of Santa Ana,its City Council,officers,officials,employees,agents,
<br /> and volunteers per policy farm.Waiver Of subrogation applies to General Liability,Automobile Liability, Professional Liability and Workers Compensation per
<br /> policy form, Professional Liability-Claims made form,defense casts included within limit.
<br /> Tu Tra rl Digitally s,g—J!by
<br /> N oa'az'1,I11 APPROVED
<br /> I V C�Uye rl os,ao:zv-oa oa' By Tu Tran Nguyen of 8:32 am,Nov 14,2U25
<br /> CERTIFICATE HOLDER 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 /> Attention: PWA—Traffic Engineering
<br /> 20 Civic Center Plaza, M-43 AUTHORIZED REPRESENTATIVE
<br /> Santa Ana CA 92701 rt-CtOH
<br /> 1988-2015 ACORD CORPORATION. All rights reserved.
<br /> ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD
<br />
|