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��o 12i16/2o25® CERTIFICATE OF LIABILITY INSURANCE DATE s�2 <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 Swell Insurance Solutions, LLC CONTACT <br /> NAME; Lindsay Pressley <br /> PO Box 682728 PHCN o t: (888)757-2012 ;A1c,Nol:(530)231-3236 <br /> Franklin, TN 37068 ADDRESS: lindsay@swellinsure.com <br /> License#• OH62941 INSURERS AFFORDINGCOVERAGE NAIL# <br /> INSURER A: The Hartford Company 30104 <br /> INSURED Monjaras&Wismeyer Group Inc. INSURERS: Technology Insurance Company 42376 <br /> DBA Return to Work Partners INSURERc: Unites States Liability Insurance Co ^_26896 <br /> 2201 E Willow St Ste D189 INSURERD: <br /> Signal Hill, CA 90766 INSURERS: <br /> INSURER F: <br /> COVERAGES CERTIFICATE NUMBER: 00009463-2493344 REVISION NUMBER: 276 <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 /> IIN-TR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER MMIDDPOLICY EFF IYYYY MM ODIYYI Y LIMITS <br /> A X COMMERCIAL GENERAL LIABILITY Y Y 72SBABJOCC6 08/2912026 08/29/2026 EACH OCCURRENCE $ 2000000 <br /> CLAIMS-MADE FXI OCCUR PREMISES(Ea occurrence) $ 110001000 <br /> MED EXP(Any one person) $ 10,000 <br /> PERSONAL&ADV INJURY $ 2,000,000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 4,000,000 <br /> �( POLICY JECOT- LOC PRODUCTS-COMPIOPAGG $ 4,000,000 <br /> OTHER: $ <br /> A AUTOMOBILE LIABILITY 72SBABJOCCS 08/29/2026 OB/2912026 Ea aerlden SINGLE LIMIT $ 2,000,000 <br /> ANY AUTO BODILY INJURY(Per person) $ <br /> OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY{Per accident $ <br /> HIRED NON-OWNED PROPERTY DAMAGE $ <br /> X AUTOS ONLY X AUTOS ONLY Per accident <br /> UMBRELLA LIAB OCCUR EACH OCCURRENCE $ <br /> EXCESS LIAB CLAIMS-MADE AGGREGATE $ <br /> DEC RETENTION$ $ <br /> WORKERS COMPENSATION YIN Y TSP4649810 48129I2025 OBl29l2026 X SPER TATUTE ORH <br /> AND EMPLOYERS' IABILITY L <br /> ANY PRCPRIETORlPARTNERIEXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 <br /> OFFICERIMEMBER EXCLUDED? N 1 A <br /> (Mandatory In NHI 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 /> C Errors&Omissions SP1018321P 08/2912026 0812912026 Occ./Ago- 1,0 O,00013,000,000 <br /> Retention $6,000 <br /> DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES (ACORD 101,Additlonal Remarks Schedule,maybe attached If more space Is required) <br /> Certificate holder is an additional insured per the Business Liability Coverage Form SI-3032 attached to this policy.Waiver of <br /> Subrogation applies in favor of the Certificate Holder per the Business Liability Coverage Form SL0000,attached to this policy. <br /> Coverage is primary and noncontributory per the Business Liability Coverage Form SLOOOO,attached to this policy.Notice of <br /> Cancellation will be provided in accordance with Form SL9013,attached to this policy.t. Tu Tran Tu Tran Ng yen by <br /> Nguyen °5:447-09T z <br /> .CERTIFICATE HOLDER CANCELLATION <br /> APPROVED . -- <br /> By Ti <br /> Tr Nguyen atS:44 pm;Jan 12;2026 <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: Human Resources Department ACCORDANCE WITH THE POLICY PROVISIONS. <br /> 20 Civic Center Plaza, AUTHORIZED PRESENTATIVE <br /> Santa Ana, CA 92701 <br /> LNP <br /> 19 - 015 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2016103) The ACORD name and Ingo are registe arks of ACORD Printed by LNP on 1 211 612 025 at 01:06PM <br />