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RICHWAT-03 LRIVERA
<br /> R�° CERTIFICATE OF LIABILITY INSURANCE FDATE,MMr°°IYYYY)
<br /> `-� 12/3/2025
<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 endorsements.
<br /> PRODUCER ONTACT Laura Rivera
<br /> Acrisure West Insurance Services,LLC PHONE PAX
<br /> 1950 W Corporate Way (AEC,No,Ext): Arc,No):
<br /> #1 E-MAIL ,Iarivera@acrisure.COm
<br /> Anaheim,CA 92801-5373 INSURERS AFFORDING COVERAGE NAIC N
<br /> INSURER A:Vigilant Insurance Company 20397
<br /> INSURER INSURERS:Federal Insurance Company 20281
<br /> Richards,Watson&Gershon INSURER C:
<br /> 350 South Grand Ave.,37th Floor INSURER D;
<br /> Los Angeles,CA 90071.3101
<br /> INSURER E
<br /> ENSURER F:
<br /> COVERAGES CERTIFICATE NUMBER: 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 /> INSR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP
<br /> LTRp pp LIMITS
<br /> A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE 1,000,000
<br /> CLAIMS-MADE X OCCUR 35293250 10/1/2025 10/1/2026 DAMAGE To RENTED 1,000,000
<br /> X X PREM SEE Ea occurr $
<br /> MED EXP(Any one arson $ 10,000
<br /> PERSONAL&ADV INJURY $ 1,000,000
<br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000
<br /> POLICY JECT [XI LOC PRODUCTS-COMPIOPAGG $ Included
<br /> OTHER:
<br /> B AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000
<br /> ANYAUTO X 74967929 10/1/2025 10/1/2026 BODILY INJURY Perperson) $
<br /> OWNED SCHEDULED
<br /> AUTOS ONLY AUTOS BODILY INJURY Per accident $
<br /> X H�RED X NpN-OWNED PROPERTY DAMAGE
<br /> A TOS ONLY AUTOS ONLY Per accident $
<br /> B X UMBRELLA LIAR X OCCUR EACH OCCURRENCE 9,aoo,00a
<br /> EXCESS LIAB CLAIMS-MADE 79611586 10/1/2025 10/1/2026 AGGREGATE 9,000,000
<br /> ❑ED RETENTION$
<br /> 13 WORKERS COMPENSATION X
<br /> AND EMPLOYERS'LU�BILITY PER
<br /> ORTH-
<br /> ANYPROPRIETORfPARTNEWEXECUTIVE YIN X 71726476 1011I2025 101112026 1,000,000
<br /> �FF'ICE fMEMRER EXCLUDED? ® N r A E.L.EACH ACCIDENT $
<br /> (MandatoryinNH' E.L.DISEASE-EA EMPLOYEE $ 1,000,000
<br /> If yes,describe under 1,000,000
<br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT
<br /> DESCRIPTION OF OPERATIONS!LOCATIONS I VEHICLES (ACORD 101,Additional Romarks Schedule,may be attached if mores ace Is required)
<br /> City of Santa Ana,Its employees,officers and agents are named as an Additional Insured as required by written contract per Endorsement Form#80-02-2367
<br /> attached. Auto,General Liability and Workers Compensation Included Waiver of Subrogation per endorsement#CA044410113180-02-2362NVC001313
<br /> attached. Coverage subject to policy terms,conditions and exclusions.
<br /> 30-day notice of cancellation applies to the certificate holder in event of cancellation except for non-payment of premium is 10 days(#80-02-9717).
<br /> TU Tra IY nlgrtally signed by
<br /> .Tu Tran Nguyen
<br /> G 7.1106-O 204
<br /> Nguyeh
<br /> APPROVED-
<br /> CERTIFICATE HOLDER CANCELLATION By To Tran-Nguyen of 7:10 am;Dec 04,2025
<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 /> y ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> 20 Civic Center Plaza,5th floor
<br /> Santa Ana,CA 92701
<br /> AUTHORIZED REPRESENTATIVE
<br /> ACORD 25(2016103) ©1988-2015 ACORD CORPORATION. All rights reserved.
<br /> The ACORD name and logo are registered marks of ACORD
<br />
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