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AC R CERTIFICATE OF LIABILITY INSURANCE OATE`MMD°""Yr' <br /> 1111 1 03/16/2026 <br /> THIS CERTIFICATE 1S 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 Christa Tell ijohn <br /> NAME <br /> Primary Source Insurance Agency Inc PHONE (800)760-2809 FAX (877)446-4631 <br /> A C No. <br /> b Ext: A!Q No <br /> 121 E Park Square E-MAIL catellijohn@fedins.com <br /> ADDRESS: <br /> INSURERIS)AFFORDING COVERAGE NA1C# <br /> Owatonna MN 55060 INSURER A: State Comp Ins Fund 35076 <br /> INSURED <br /> INSURER 8 <br /> Sltarep Construction Services,Inc' INSURER C: <br /> 301 E Arrow Hwy INSURER D: <br /> Ste 105 INSURER E: <br /> San Dimas CA 91773-3364 11111ER1: <br /> COVERAGES CERTIFICATE NUMBER: 26-27 WC REVISION NUMBER: <br /> THIS iS TO CERTIFY THATTHE 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 MAYBE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BYTHE 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 AJUL bIJUR POLICY P LI Y EXP <br /> LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MMIDDIYYYY MMIDDIYYYY LIMITS <br /> COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ <br /> CLAIMS-MADE OCCUR D <br /> PREMISES Ea occurrence $ <br /> ME EXP(Any one person) $ <br /> PERSONAL&ADV INJURY $ <br /> GEN'LAGGREGATE LIMITAPPLIES PER: GENERALAGGREGATE $ <br /> POLICY PRO- <br /> JECT LOC PRODUCTS-COMPtOPAGO $ <br /> OTHER: $ <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ <br /> Ea accident <br /> ANYAUTC BODILY INJURY(Per person) $ <br /> OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ <br /> HIRED NON-OWNED PROPERTY DAMAGE $ <br /> AUTOS ONLY AUTOS ONLY Per accident <br /> UM BRELLA LIAR OCCUR EACH OCCURRENCE $ <br /> EXCESS LIAR HCLAIMS-MADE AGGREGATE $ <br /> DED I I RETENTION$ $ <br /> WORKERS COMPENSATION X STATUTE ORH <br /> AND EMPLOYERS'LIABILITY <br /> ANY PRO PRIETCRIPARTNERIEXECUTIVE YIN E.L.FACH ACCIDENT $ 1,000,000 <br /> A OFFICERIMEMBER EXCLUE NIA Y 9395661-2026 02/19/2026 02/19/2027 <br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 <br /> If yes,describe under 1,000,000DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ <br /> DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached If more space is required) <br /> Project No:25-7524 Angels Cool Pavement Basketball Court and ADA Improvements, <br /> The Workers Compensation coverage contains a waiver of subrogation in favor of the certificate holder subject to the conditions of the Waiver of <br /> Subrogation. <br /> f'IPPRO iI ED <br /> CERTIFICATE HOLDER CANCELLATION I Sy Tit Tran Nguyen af.12 30 prn,;Mar 2,T k04 <br /> SHOULD ANY OF THEABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN <br /> City of Ana ACCORDANCE WITH THE POLICY PROVISIONS. <br /> 20 Civic Center Plaza <br /> AUTHORIZED REPRESENTATIVE <br /> Santa Ana CA 92702 <br /> ©1988.2015 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD <br />