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CWE0000-01 KSITYAMALA
<br /> AcoRa CERTIFICATE OF LIABILITY INSURANCE D 19/20Y5
<br /> 12l19I2025
<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 License#0757776 cAME:Nracr Donna Jones
<br /> NA
<br /> HUB International Insurance Services Inc. PHONE FAx
<br /> 600 Corporate Pointe (AIC.No,Ext): (Arc,No):
<br /> Suite 600 E-MAIL d ones hubinternational.com
<br /> ADDRESS: onna.1
<br /> Culver City,CA 90230
<br /> INSURER S APFORDING COVERAGE NAIC H
<br /> INSURER A:Crum&Forster Specialty Insurance Company 44520
<br /> INSURED INSURER B:National Fire&Marine 20079
<br /> 1561 E.Orangethorpe Avenue
<br /> CWE INSURER C:Pacific Compensation Insurance Corn a�555
<br /> Suite240 INSURERD: _
<br /> Fullerton,CA 92831 INSURER E
<br /> 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 /> IL SR TYPE OF INSURANCE ADDDL SWVQUIB POLICY NUMBER POLICY EFF POLICY EXP LIM]TS
<br /> A COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000
<br /> CLAIMS-MADE )( OCCUR X X 1218/2025 121812026 EPK-164748 DAMAGE TO RENTED 100,000
<br /> PREMISES Ea occurrence $
<br /> MED EXP An one erson $ 10,000
<br /> PERSONAL&ADV INJURY $ 2,000,000
<br /> GENT AGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE $ 4,000,000
<br /> _ POLICY PRO LOC PRODUCTS-COMP/OPAGG $ 4,000,000
<br /> OTHER: POLLUTION LIABI $ 2,000,00a
<br /> B AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,005,600
<br /> Ea accident $
<br /> IxANY AUTO X 72APB011724 616/2025 6/6/2026 BODILY INJURY Perperson) $OWNED _
<br /> AUTOS ONLY X AUTOS
<br /> OS BODILY INJURY tPer accident $
<br /> HIRED X NON-OWNED PP
<br /> AUTOS AUTOS ONLY AUTOS ONLY Per accident $ _
<br /> A
<br /> C UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,000
<br /> X EXCESS LIAR CLAIMS-MADE EFX-141385 12l8l2025 12I8l2026 AGGREGATE $ 1,000,000
<br /> DED RETENTION$
<br /> C AND EMPLCOMPENSATION
<br /> YERS L A IOITNY X STAT E ORH
<br /> ANY PRO PRI ETOR/PARTNERIEXECUTIVE YIN X 1025483 1211l2025 12l112026 1,000,000
<br /> OFFICERIMEMBER EXCLUDED? NIA E.L EACk ACCIDENT $
<br /> tMandatory in NH► 1,000,U00
<br /> H yes.describe under
<br /> E.L.DISEASE-EA EMPLOYE $
<br /> DESCRIPTION OF OPERATIONS below E.L.DISFASE-POLICY LIMIT $ 1,000,000
<br /> A Professional Liabill X EPK-164748 12/8/2025 121812026 Each Wrongful Act 2,000,000
<br /> A Professional Liabili X EPK-164748 121812025 121812026 Aggregate 4,000,000
<br /> DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES (ACORD 101.Additional Remarks Schedule,may be attached it more space is required)
<br /> Re:Project Name:RFP 20-102.
<br /> The City of Santa Ana,20 Civic Center Plaza,Santa Ana,California 92701;officers,agents,employees,representatives and volunteers are Additional Insured
<br /> with regard to General Liability when required by written contract per the attached endorsement forms#EN0111 02111 and#EN0147 11111.Primary&Non-
<br /> Contributory wording applies with regard to General Liability when required by written contract per the attached endorsement form#EN0147 11111,Waiver of
<br /> Subrogation with regard to General Liability applies when required by written contract per the attached endorsement form#EN0147 11111.Per Project
<br /> Aggregate applies with regard to the General Liability policy,when required by written contract,per endorsement to follow.
<br /> SEE ATTACHED ACORD 101
<br /> APPROVED
<br /> CERTIFICATE HOLDER By Tu Tran Nguyen at7:11 am,Dec 23,2025' CANCELLATION
<br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> City of Santa Ana Tu Tran Dig€ai1ysigred6y THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br /> T,Tran Nguyen ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> Attn:PWA PFFR DMA 20 s.1223
<br /> 20 Civic Center Ng uyen mezoi.aaoo•
<br /> Santa Ana,CA 92701 AUTHORIZED REPRESENTATIVE
<br /> ACORD 25(2016/03) (D 1988-2015 ACORD CORPORATION. All rights reserved.
<br /> The ACORD name and logo are registered marks of ACORD
<br />
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