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ACO ©'�w 1 CERTIFICATE OF LIABILITY INSURANCE DATE(MMIQDIYYYYI
<br /> 8I28/2026 8/26/2025
<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(ies)must have ADDITIONAL INSURED provisions or be endorsed.
<br /> If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy, certain po]ICles 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 Lockton Companies,LLC. CONTACT
<br /> NAME:
<br /> DBA Lucktnn Insurance Brokers,LLC in CA PHONE FAX
<br /> AIC No
<br /> CA license#OF15767 EMAIL
<br /> 444 W.47th St.,Ste.900 ADDRESS:
<br /> Kansas City MO 64I12-1906 INSURER(S)AFFORDING COVERAGE NAIC#
<br /> (816)960-9000 kcasu@locktDn.com INSURER A:Zurich American Insurance Company 16535
<br /> INSURED DUDEK INSURER B:American Guarantee and Liab.Ins.Co. 26247
<br /> 1475838 605 THIRD STREET INSURER C:Continental Casualty Company Compoy 20443
<br /> ENCINITAS CA 92024 INSURER Q:
<br /> INSURER E
<br /> INSURER F
<br /> COVERAGES CERTIFICATE NUMBER: 16765248 REVISION NUMBER: XXXXXXX
<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 SUER POLICY EFF POLICY EXP
<br /> LTR INSD WVD POLICY NUMBER MMIDDIYY MMIDDIYYYY LIMITS
<br /> A X COMMERCIAL GENERAL LIABILITY Y Y GLOO146311 8/28/2025 9/28/2026 EACH OCCURRENCE $ 1 000 000
<br /> :::pCLAIMS-MADE n l OCCUR PREMISES Ea occur ence $ 100,000
<br /> MED EXP(Any one person) $ 10,000
<br /> Pt=RSONAL&ADV INJURY s1,000,000
<br /> GEN'LAGGREGATE LIMIT APPLIES PER: GENERALAGGRFGATE $ 2,000,000
<br /> POLICY u JEp FX] LOC PRODUCTS-COMPIOPAGG $ 2,000,000
<br /> OTHER: $
<br /> A AUTOMOBILE LIAB]LITY Y Y BAP0146329 8/28/2025 8/28/2026 COMBINED SINGLE LIMIT $
<br /> Ea accident 1,000,000
<br /> X ANY AUTO BODILY INJURY(Per person) $ XXXXXxX
<br /> OWNED 8CHEOULED BODILY INJURY(Per accidenl) $
<br /> AUTOS ONLY AUTOS XXXXXXX
<br /> HIRED NON-OWNED PROPERTY DAMAGE $ XXXXXXX
<br /> AUTOS ONLY AUTOS ONLY Per accident
<br /> $ XXXXXXX
<br /> B X UMBRELLA LIAR X OCCUR N Y AUC0146407 8/28/2025 8/28/2026 EACH OCCURRENCE $ 1,000,000
<br /> EXCESS LIAB CLAIMS-MADE AGGREGATE $ 1,000,000
<br /> ❑ED I I RETENTION$_ $ XXXXXXX
<br /> WORKERS COMPENSATION Y X sr PER OTH A AND EMPLOYERS'LIABILITY YIN -
<br /> WC0146330 8/28/2025 8/28/2026 AruTE I I ER
<br /> ANY PROPRIETORIPARTNERIEXECUTIVE E.L.EACH ACCIDENT $ 1.000.000
<br /> OFFiGFRIMEM5FREXCI.017 FN] NIA'
<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 /> C PROFESSIONAL N N EEH591932835 INCL POLL 112112111 111112121 PER CLAIM$2,000,000
<br /> LIABILITY AGGREGATE$2,000,000
<br /> DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORO 101,Additional Remarks Schedule,may be attached If more space is required)
<br /> CITY OF SANTA ANA,OFFICERS,AGENTS,EMPLOYEES AND VOLUNTEERS ARE ADDITIONAL INSURED ON GENERAL AND AUTO LIABILITY
<br /> COVERAGE ON A PRIMARY,NON-CONTRIBUTORY BASIS,AS REQUIRED BY WRITTEN CONRACT WAIVER OF SUBROGATION IN FAVOR OF THE
<br /> ADDITIONAL INSURED APPLIES ON WORD COMP,GENERAL,AUTO AND UMBRELLA LIABILITY COVERAGE,AS REQUIRED BY WRITTEN CONTRACT
<br /> AND WHERE ALLOWED BY LAW.COVERAGE IS SUBJECT TO THE TERMS AND CONDITIONS OF TEE POLICY.
<br /> APPROVED
<br /> By Tu Tran Nguyen at 7:44 am,Sep OZ 2025
<br /> CERTIFICATE HOLDER CANCELLATION See Attachments
<br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> 16765248 THE EXPIRATION DATE THEREOF, NOTICE WILL 13E DELIVERED IN
<br /> CITY OF,SANTA ANA ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> ATTENTION:PUBLIC WORKS AGENCY,
<br /> CIP/DESIGN ENGINEERING AUTHORIZED REPRESENTATIV.
<br /> 20 CIVIC CENTER PLAZA
<br /> SAN A ANA CA 92702,M-36a
<br /> 4,&
<br /> p 1988L2015 ACORD CORPORATION. All rights reserved.
<br /> ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD
<br />
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