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Ac ® DATE(MMIUDIYYYY) I`� CERTIFICATE OF LIABILITY INSURANCE J5/7/2025 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such ondorsement(s), PRODUCER LUNIAUI NAME: Jane Parmenter Parmenferinsurance A ene PHONE 949 R29-0516 g y AIC,No Ext: ) (AIC,No): 27758 Santa Margarita Parkway#283 ADDRESS: janeCaparmenterins.com INSURER(S)AFFORDING COVERAGE NAIC# Mission Viejo CA 92691 INSURER A: Hartford 11000 INSURED INSURER B: Iiiscox-PRO 10200 J.Smith and T.Muli,[tic INSURER C: INSURER O: 27525 Puerta Real Unit 300-1 INSURER E: Mission Viejo CA 9269I INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MMJDDIYYYY) (MM/DDlYYYY) LIMITS V COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000 /� CLAIMS-MADE r—KI OCCUR PREMISES(Ea occurrence) $ 100,000 MED EXP(Any one person) $ 5000 A X Primary and Noncontributory Y Y 72SBABG 1946 04/29/2025 04/29/2026 1 PERSONAL&ADV INJURY $ 2,000,000 GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 4,000,000 POLICY PE� LOC PRODUCTS-COMPIOPAGG $ S/T Gen Agg OTHER: I S AUTOMOBILE LIABILITY (Ea accident) 5 ANY AUTO BODILY INJURY(Per person) 5 A OWNED SCHEDULED Y Y 72SBABG1946 04/29/2025 04/29/2026 BODILY INJURY(Per accident) S AUTOS ONLY AUTOS y HIRED yy NON-OWNEDPROPERTY UAMA61r /� AUTOS ONLY /C AUTOS ONLY (Per accident) 5 CGL NNOA Limit 5 2,000,000 UMBRELLA LIAB OCCUR EACH OCCURRENCE S EXCESS LIAR HCLAIMS-MADE AGGREGATE $ DEO I I RETENTION S I $ WORKERS COMPENSATION STATUTE ER PER AND EMPLOYERS'LIABILITY YIN ANY PROPRIETORIPARTNERIEXEGUTIVE El E.L.EACH ACCIDENT $ OFFICE RIME MEER EXCLUDED? N i A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below I E.L.DISEASE-POLICY LIMIT $ Each Claim 2,000.000 B Professional Liability Y ANE5329238.24 04/29/2025 04/29/2026 Aggregatc 2,000.000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule„may be attached If more space is required) The City,its officers,officials,employees, and volunteers are to be covered as additional insureds on the CGL Dlgitaily signed policy with respect to liability arising out of work or operations Tu Tran bymr erformed b or on behalf of she Consultant including materials, arts, "Q"ye P Y P Nguyen"-1.ozs.os." APPROVED or equipment furnished in connection with such work or operations. 3:as:oo-0ruu Description of Operations:On-Call Engineering A-2023-075-05 By Tu Tran Nguyen at 1:42 pm,May 22,2025 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN City or Santa Ana,Attn PWA Parks,Fleet&Facilities ACCORDANCE WITH THE POLICY PROVISIONS. 20 Civic Center Plaza(M-30) AUTHORIZED REPRESENTATIVE PO Box 1988 Ja a P0.Y se.Jir Santa Ana CA 92702 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD