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® DATE(MM/DD/YYYY)
<br /> ACC OR"
<br /> � CERTIFICATE OF LIABILITY INSURANCE 6/23/2026
<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 INSURERS),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: Steven Lau
<br /> SJL Insurance Services Inc PHONE FAX
<br /> 626 387-6688
<br /> A/C,No,Ext: ( ) (A/C,No):
<br /> 539 E GARVEY AVE ADDRESS: steven@sjlins.com
<br /> INSURER(S)AFFORDING COVERAGE NAIC#
<br /> MONTEREY PARK CA 91755 INSURER A: JAMES RIVER INS CO 12203
<br /> INSURED INSURER B: National Fire&Marine Insurance Co
<br /> CALI STATE PAVING INC. INSURER C: Berkley Net
<br /> 6699 CHADBOURNE AVE INSURER D:
<br /> INSURER E:
<br /> RIVERSIDE CA 92505-2007 INSURER 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 /> LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS
<br /> X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
<br /> CLAIMS-MADE OCCUR PREMISES(Ea occurrence) $ 50,000
<br /> MED EXP(Any one person) $ 1,000
<br /> A Y P0000013738 03/01/2026 03/01/2027 PERSONAL&ADV INJURY $ 1,000,000
<br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000
<br /> X POLICY ❑ECT ❑LOC PRODUCTS-COMP/OP AGG $ 2,000,000
<br /> OTHER: $
<br /> AUTOMOBILE LIABILITY (Ea accident) $ 1,000,000
<br /> ANY AUTO BODILY INJURY(Per person) $
<br /> B OWNED AUTOS ONLY X AUTOSULED Y 72APS132411 04/04/2026 04/04/2027 BODILY INJURY(Per accident) $
<br /> HIRED NON-OWNED HF<UHEK I Y DAMAGE $
<br /> X AUTOS ONLY X AUTOS ONLY (Per accident)
<br /> UMBRELLA LAB M
<br /> OCCUR EACH OCCURRENCE $ 2,000,000
<br /> A X EXCESS LAB CLAIMS-MADE Y P0000013758 03/01/2026 03/01/2027 AGGREGATE $ 2,000,000
<br /> DED I I RETENTION$ $
<br /> WORKERS COMPENSATION X STATUTE ER
<br /> AND EMPLOYERS'LIABILITY
<br /> ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT $ 1,000,000
<br /> C OFFICER/MEMBER EXCLUDED? Fy] N/A Y 4160238711-1 06/25/2026 06/25/2027
<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 /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
<br /> CITY OF SANTA ANA,ITS CITY COUNCIL,OFFICIALS,EMPLOYEES,AGENTS,AND VOLUNTEERS ARE TO BE COVERED AS ADDITIONAL INSUREDS ON
<br /> CONTRACTOR'S AL POLICIES WITH RESPECT TO LIABILITY ARISING OUT OF WORK OPERATIONS PERFORMED BY OR ON BEHALF OF CONTRACTOR
<br /> INCLUDING MATERIALS,PARTS,AND EQUIPMENT FURNISHED IN CONNECTION WITH SUCH WORK OR OPERATIONS AND AUTOMOBILES OWNED,
<br /> LEASED,HIRED,OR BORROWED BY OR ON BEHALF OF CONTRACTOR.ADDITIONAL INSURED STATUS CAN BE PROVIDED IN THE FORM OF AN
<br /> ENDORSEMENT TO CONTRACTOR'S INSURANCE.TEN(10)DAYS PRIOR WRITTEN NOTICE FOR NON-PAYMENT AND THIRTY(30)DAYS PRIOR
<br /> WRITTEN NOTICE FOR POLICY CANCELLATION SHALL BE PROVIDED TO THE CITY.
<br /> CERTIFICATE HOLDER APPROVED CANCELLATION
<br /> By Tu Tran Nguyen at 7.27 am,Jun 25,202'6
<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:Public Works Agency AUTHORIZED REPRESENTATIVE
<br /> 20 CIVIC CENTER PLAZA siv-v' ...kUU
<br /> SANTA ANA CA 92702
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<br /> ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD
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