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DATE(MMIDDIYYYYI
<br /> A��EP CERTIFICATE OF LIABILITY INSURANCE
<br /> 02)1 olza2s
<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 endorsement(s).
<br /> PRODUCER - NTA T
<br /> NAME:
<br /> MARSH RISK&INSURANCE SERVICES
<br /> FOUR EMBARCADERO CENTER,SUITE 1100 PHONE
<br /> N t: FAX
<br /> No):
<br /> CALIFORNIA LICENSE NO.0437153 EMAIL
<br /> SAN FRANCISCO,CA 94111 ADDRESS:
<br /> INSURERS AFFORDING COVERAGE NAIC#
<br /> CN101483688-SCAL-CAS-26=27 GLALW CA INSURERA: Safety National Casualty Cori). 151D5
<br /> INSURED INSURER B:
<br /> KAISER FOUNDATION HEALTH PLAN,INC.
<br /> KAISER FOUNDATION HOSPITALS INSURER c:
<br /> 393 EAST WALNUT STREET INSURER D:
<br /> PASADENA,CA 91180
<br /> INSURER E:
<br /> INSURER F:
<br /> COVERAGES CERTIFICATE NUMBER: SEA-003811693-21 REVISION NUMBER: 13
<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 /> EXP
<br /> INSR TYPE OF INSURANCE ADDL SUER POLICY NUMBER MMIDDYIYYYY MM pDYIYYYY LIMITS
<br /> LTR
<br /> A X COMMERCIAL GENERAL LIABILITY GL 4046017 0110112026 D110112027 EACH OCCURRENCE $ 5,000,D00
<br /> DAMAGE TO RENTED
<br /> CLAIMS-MADE 57 OCCUR PREMISES Ea Dccu ence $ 5,000,000
<br /> I MED EXP(Any one person) $ 10,D00
<br /> PERSONAL&ADVINJURY $ 5,000,000
<br /> GEN'LAGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE $ 5,000,000
<br /> X POLICY 0 PRO ❑
<br /> JECT LOC PRODUCTS-COMPIDP AGG $ 5,000,000
<br /> OTHER: $
<br /> A AUTOMOBILE LIABILITY CA6675S80 01/01/2026 0110112027 Ea aBc EDD SINGLE LIMIT $ 4,000,000
<br /> A X ANY AUTO i$1,000,000 SIR I BODILY INJURY(Per person) $
<br /> OWNED SCHEDULED
<br /> AUTOS ONLY AUTOS - BODILY INJURY(Per acddent) $
<br /> HIRED NON-OWNED PROPERTYDAMAGE $
<br /> AUTOS ONLY AUTOS ONLY Per awident
<br /> $
<br /> UMBRELLALIAB OCCUR EACH OCCURRENCE $
<br /> EXCESS LIAB CLAIMS-MADE AGGREGATE $
<br /> DIED RETENTION$ $
<br /> A WORKERS COMPENSATION [ SP4067916 01101/2026 01/01/2027 X I STATUTE E
<br /> S,LR.$5,000,000 RH
<br /> AND EMPLOYERS'LIABILITY YIN
<br /> ANYPROPRIETCRIPARTNERIEXECUTIVE ' E.L.EACH $ 5,000,00D
<br /> EN] NIA
<br /> OFFICERIMEMBEREXCLUDED7
<br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 5,000,000
<br /> If yes,describe under 5,000,000
<br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $
<br /> i
<br /> DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached it more space is required)
<br /> REQUEST#RC011714
<br /> THE CITY OF SANTA ANA,ITS OFFICERS,OFFICIALS,EMPLOYEES AND VOLUNTEERS ARE INCLUDED AS ADDITIONAL INSURED AS RESPECTS GENERAL LIABILITY AND AUTOMOBILE LIABILITY
<br /> TO THE EXTENT REQUIRED BY WRITTEN CONTRACT. THE GENERAL LIABILITY POLICY IS PRIMARY AND NON-CONTRIBUTORY WHERE REQUIRED BY WRITTEN CONTRACT. POLICIES INCLUDE,!
<br /> WAIVER OF SUBROGATION WHERE REQUIRED BY WRITTEN CONTRACT AND ALLOWED BY LAW.
<br /> APPROVED
<br /> CERTIFICATE HOLDER CANCELLATION By Tu Tran Nguyen at 30:55 am,Mar 11,2026
<br /> CITY OF SANTA ANA SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> 20 CIVIC CENTER PLAZA THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br /> SANTA ANA,CA 92701 ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> AUTHORIZED REPRESENTATIVE
<br /> of Marsh Risk&Insurance Services
<br /> O 1988-2016 ACORD CORPORATION. All rights reserved.
<br /> ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD
<br />
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