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Ac DATE(MMIDDIYYYY) <br /> CERTIFICATE OF LIABILITY INSURANCE 03/13/2026 <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 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 lleu of such endomement(s). <br /> PRODUCER CONTACT Christina Kaprielian <br /> NAME: <br /> SultivanCurtislvlonroe,LLC-#OE83670 AHCNNoExt: (949)250.7172 glCNo: (949)852-9762 <br /> Claims Reporting(800)427-3253 E-MAIL ckaprielian@sullicurt.com <br /> ADDRESS: <br /> 2010 Main St.,Ste.700 INSURER(S)AFFORDING COVERAGE NAIC# <br /> Irvine CA 92614 INSURERA: Capitol Specialty Insurance 1032a <br /> INSURED INSURER B: California Automobile Insurance Co, 38342 <br /> Siterep Construction Services,Inc. INSURER C: Accelerant Specialty Insurance Company 19489 <br /> 301 E Arrow Hwy#105 INSURER D: <br /> INSURER E: <br /> San Dimas CA 91773 INSURER F: <br /> COVERAGES CERTIFICATE NUMBER: 26-27 GLICAUIUMB/PL REVISION NUMBER: <br /> THIS IS TO CERTIFYTHAT 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 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 /> t TR TYPE OF INSURANCE INSD WVD POLICY NUMBER MM DONYYY MMILDD YYYY LIMITS <br /> X COMMERCIALGENERALLIABILITY EACHOCCURRENCE $ 1,000,000 <br /> GLAIMS•MADE ®OCCUR PREMISES(Ea occurrence) $ 100,000 <br /> VIED EXP(Any one person) $ 5,000 <br /> A Y Y CT20200053-01 03/17/2026 03/17/2027 PERSONAL&ADV INJURY $ 1,000,000 <br /> GEN'LAGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $ 2,000,000 <br /> POLICY ❑PECOT- ® LOC. PRODUCTS-COMPIOPAGG $ 2,000,000 <br /> OTHER: $ <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 <br /> Ea accident <br /> X ANYAUTO BODILY INJURY(Per person) $ <br /> B OWNED SCHEDULED Y Y BA040000099047 03/10/2026 03/10/2027 BODILY INJURY(Per accident) $ <br /> AUTOSCNLY AUTOS . <br /> X HIRED NON-OWNED PROPERTY DAMAGE $ <br /> AUTOS ONLY /� AUTOS ONLY Per....tort <br /> UMBRELLA UAB OCCUR EACH OCCURRENCE $ 1,000,000 <br /> A X EXCESS LIAB HCLAIMS-MADE CX20260036-01 03/17/2026 03/17/2027 AGGREGATE $ 1,000,000 <br /> DEC) I I RETENTION$ $ <br /> WORKERS COMPENSATION PER <br /> R� <br /> AND EMPLOYERS'LIABILITY Y I N <br /> ANY PROPRIETORIPARTNERIEXECJTIVE E.L.EACH ACCIDENT $ <br /> OFFICERIMEMBEREXCLUDED? ❑ NIA <br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ <br /> Ifyes,describe under <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 3 <br /> Contractors Pollution and Professional Per Claim $2,000,000 <br /> C Liability S0073PLO22483-00 0311712C26 03Y1712027 Aggregate $2,000,000 <br /> Retention $10,000 <br /> DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) <br /> Re:PROJECT 25.7524 <br /> ANGELS COOL PAVEMENT BASKETBALL COURT AND ADA IMPROVEMENTS <br /> City of Santa Ana,its City Gouncil,officers,officials,employees,agents,and volunteers are added as Additional Insured with Waiver of Subrogation per <br /> attached forms.Insurance is Primary and Non-Contributory. <br /> APPROVED <br /> CERTIFICATE HOLDER CANCELLATION <br /> r lalgzryaat f2Afaa�2i)2' <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 /> 20 CIVIC Center Plaza <br /> AUTHORIZED REPRESENTATIVE <br /> Santa Ana CA 92701 Uf <br /> O 1988-2015 ACORD CORPORATION. All rights reserved. <br /> ACORD 26(2016103) The ACORD name and logo are registered marks of ACORD <br />