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AC"REP® CERTIFICATE OF LIABILITY INSURANCE DATE(MM@DIYYYY)
<br /> 03/06/2026
<br /> THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLYAND 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 Tina Cowie
<br /> NAME:
<br /> Cornerstone Specialty Insurance Services,Inc. PHONE (714)731-7700 FAx (714)731-7750
<br /> AIC No Ext: AIC,No):
<br /> 14252 Culver Drive,A299 ADDRIE55: tlna@Gornerstonespecialty.cem
<br /> INSURERS)AFFORDING COVERAGE NAIC#
<br /> Irvine CA 92604 INSURER A: Travelers Indemnity Co of Conn 25682
<br /> INSURED INSURER B: Travelers Property Casualty Co 25674
<br /> JASON ADDISON SMITH CONSULTING SERVICES,INC., INSURERC: Arch Insurance Company 11150
<br /> ❑BA JAS PACIFIC INSURER D:
<br /> 13925 City Center Drive,Suite 200 INSURER E:
<br /> Chino Hills CA 91709 INSURER F:
<br /> COVERAGES CERTIFICATE NUMBER: 25126 COVERAGES REVISION NUMBER:
<br /> THIS IS TO CERTIFYTHATTHE 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 CONTRACTOR 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 /> INSR AUUL POLICY EFF POLICY EXP
<br /> LTR TYPE OF INSURANCE INSD WVD POLICYNUMBER MMIDDIYYYY) (MMMDrYYYYI LIMITS
<br /> X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2.000,000
<br /> ELATE
<br /> CLAIMS-MADE Zf!\ OCCUR PREMISES Ea aecunence $ 1.000,000
<br /> X BLNKT ADD°L INSUREDlP 8 NG MED EXP Any one person] $ 5,000
<br /> A X BLNKT WVR OF SUBRO Y Y 680-1 H359042 08/0812025 08/08/2026 PERSONAL&ADV INJURY $ 2,000,000
<br /> GEN'L AGGREGATE LIMIT APPL€ES PER:. GENERALAGGREGATE $ 4,000,000
<br /> POLICY Eg jECT LOC 4,000,000
<br /> PRODUCTS-COMPlOPAGG $
<br /> OTHER: S
<br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,0a0,000
<br /> (Ea accident
<br /> X ANYAUTO BODILY INJURY(Per person) $
<br /> A OWNED SCHEDULED Y Y BA-DS426316 08/0812025 08/08/2026 BODKYINJURY Per accident $
<br /> AUTOS ONLY AUTOS ( }
<br /> HIRED NON-OWNED PROPERTY DAMAGE
<br /> AUTOS ONLY AUTOS ONLY Per accident $
<br /> X UMBRELLA DAB X OCCUR $ 5,000.000
<br /> EACH OCCURRENCE
<br /> B EXCESS LIAB CLAIMS MADE Y Y CUP-3429T370 08/08/2025 08108/2026 AGGREGATE $ 5,000,000
<br /> DEO I X RETENTION$ 0 S
<br /> WORKERS COMPENSATION PER OTH-
<br /> AND EMPLOYERS'LIABILITY YIN X STATUTE ER
<br /> B ANY PROPRIETORIPARTNERlEXECUTIVE �yry�� EL EACH ACCIDENT $ 1,000,000
<br /> OFFICERIMEMBER EXCLUDED? LJ NIA Y UB-SK37343A 08/0812025 08/08/2026
<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 /> Professional Liability
<br /> Each Claim $2,000.000
<br /> C Claims Made PAAEP0184400 08/08/2025 08105/2026 Annual Aggregate $4,000,000
<br /> DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,maybe attached if more space is required)
<br /> RE:RFQ 2025-130 for On-Call Building Safety Division Services
<br /> City,its City Council,its officers,officials,employees,agents,and volunteers are Additional Insured for General Liability but only if required by written
<br /> contract with the Named Insured prior to an occurrence and as per attached endorsement.Coverage is subject to all policy terms and conditions.*30 days
<br /> notice of cancellation,except for 10 days notice for non-payment of premium.For Professional Liability coverage,the aggregate limit is the total insurance
<br /> available for all covered claims reported within the policy period.
<br /> [�y�fTT
<br /> VEDguyen at�5aMar 26,2026
<br /> CERTIFICATE HOLDER CANCELLATION
<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 /> ATTN:Planning&Building Agen
<br /> 20 Civic Center Plaza AUTHORIZED REPRESENTATIVE
<br /> Santa Ana CA 92701
<br /> O 1988-2015 ACORD CORPORATION. All rights reserved.
<br /> ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD
<br />
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