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DATE(MM/DD/YYYY)
<br /> A�" CERTIFICATE OF LIABILITY INSURANCE 6/18/2026
<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 /> PRODUCER CONTACT
<br /> NAME: Brie McConnell
<br /> Patriot Growth Insurance Services, LLC PHONE FAX
<br /> 7777 Center Avenue, Suite 600 A/C No Ext: 714-733-6223 A/C,No:
<br /> E-MHuntington Beach CA 92647 ADDRESS: brie.mcconnell@patriotgis.com
<br /> INSURER(S)AFFORDING COVERAGE NAIC#
<br /> INSURERA: GuideOne Insurance Company 15032
<br /> INSURED CAFUELS-01 INSURER B: Insurance Company of the West 27847
<br /> AAA Oil, Inc. California Fuels and Lubricants; FOPCO, Inc. INSURERC: Gemini Insurance Company 10833
<br /> 11621 Westminster Avenue
<br /> Garden Grove CA 92843 INSURERD: GENERAL STAR IND CO 37362
<br /> INSURERE:Ascot Speciality Insurance Company 45055
<br /> INSURER F:
<br /> COVERAGES CERTIFICATE NUMBER:201910562 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 EFF POLICY EXP LIMITS
<br /> LTR INSD WVD POLICY NUMBER MM/DD MM/DD
<br /> A X COMMERCIAL GENERAL LIABILITY Y Y 62P100999-05 5/1/2026 5/1/2027 EACH OCCURRENCE $1,000,000
<br /> CLAIMS-MADE � OCCUR PREMISES DAMAGE TO
<br /> PREMISES Ea occurrence)
<br /> ccurrence $100,000
<br /> MED EXP(Any one person) $0
<br /> PERSONAL&ADV INJURY $1,000,000
<br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000
<br /> X POLICY� PECOT- LOC PRODUCTS-COMP/OP AGG $2,000,000
<br /> OTHER: $
<br /> A AUTOMOBILE LIABILITY Y Y 62P100999-05 5/1/2026 5/1/2027 COMBINED SINGLE LIMIT $1,000,000
<br /> Ea accident
<br /> X ANY AUTO BODILY INJURY(Per person) $
<br /> OWNED SCHEDULED BODILY INJURY(Per accident) $
<br /> AUTOS ONLY AUTOS
<br /> X HIRED LXX
<br /> NON-OWNED FIR ERTYDAMAGE $
<br /> AUTOS ONLY AUTOS ONLY Per accidentX Poll Liab MCS 90 Motor Truck Cargo $$50,000
<br /> C UMBRELLALIAB X OCCUR GVE100367001 5/1/2026 5/1/2027 EACH OCCURRENCE $2,000,000
<br /> X EXCESS LAB CLAIMS-MADE AGGREGATE $2,000,000
<br /> DED RETENTION$ $
<br /> B WORKERS COMPENSATION Y WSD506056306 5/1/2026 5/1/2027 X PER OTH-
<br /> AND EMPLOYERS'LIABILITY Y/N STATUTE ER
<br /> ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $1,000,000
<br /> OFFICE R/M EMBER EXCLUDED? ❑ N/A
<br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000,000
<br /> If yes,describe under
<br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000
<br /> E Pollution Liability ENPM2510001758-01 9/24/2025 9/24/2026 Limit $1,000,000
<br /> B USL&H WSD506056306 5/1/2026 5/1/2027 Statutory $1,000,000
<br /> D Excess(2nd Layer) IXG671934E 5/1/2026 5/1/2027 OCC/AGG $3,000,000
<br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached if more space is required)
<br /> RE: Facilities of HVAC, Maintenance and Repairs,Various locations in Santa Ana.
<br /> City of Santa Ana, it's officers,officials,employees and volunteers are Additional Insured as respects to General Liability&Auto Liability per the terms of the
<br /> attached endorsement forms.Waiver of Subrogation applies to General Liability,Auto and Workers Compensation per the terms of the attached endorsement
<br /> form.
<br /> APPROVED
<br /> By Tu Tran Nguyen at 2:32 pm,Jun 18,2026
<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 /> Attn: Public Works
<br /> 215 S Center St. AUTHORIZED REPRESENTATIVE
<br /> Santa Ana CA 92703
<br /> ©1988-2015 ACORD CORPORATION. All rights reserved.
<br /> ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD
<br />
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