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JLEEENG-01 MICHAELA
<br /> .�► a CERTIFICATE OF LIABILITY INSURANCE D 1 11l1/221112025Y)
<br /> 025
<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 lieu of such endorsement(s).
<br /> PRODUCER License#OE67768 CONCT Andrea Michael
<br /> NAMETA:
<br /> IOA Insurance Services PHONE FAX
<br /> 3875 Hopyard Road (AIC,No,Ext):(925)249-795$ (AfC,No):
<br /> Suite 200 A-o A'Ess:Andrea.Michael@ioausa.com
<br /> Pleasanton,CA 94588
<br /> INSURERS AFFORDING COVERAGE NAIC fx
<br /> INSURER A:RLI Insurance Company 13056
<br /> INSURED INSURER B:Arch Insurance Company 11150
<br /> JLee Engineering,Inc. INSURER C
<br /> 3871 E Colorado Boulevard,Suite 200 INSURER D
<br /> Pasadena,CA 91107
<br /> 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 /> INSR ADDL SUBR POLICY EFF POLICY EXP
<br /> LTRTYPE OF INSURANCE D POLICY NUMBER pp LIMITS
<br /> A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,500
<br /> CLAIMS-MADE Fsvl OCCUR PSBOO10319 911/2025 9111202E PREMISES I a ac TO cu r ce $. 1'000'000
<br /> MED EXP(Any one erscn $ 10,000
<br /> PERSONAL 9 ADV INJ URY $ 2,000,000
<br /> GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 4,000,000
<br /> POLICY j GT LOG PRODUCTS-COMPIOPAGG $ 4,000,000
<br /> OTHER;
<br /> A AUTOMOBILE LIABILITY GEOMBI E SINGLE LI
<br /> DMIT $ 1,000,000
<br /> ANY AUTO PSA0003335 9/1/2025 9l112026 BODILY INJURY Per person $
<br /> OWNED SCHEDULED BODILY INJURY Per accident $
<br /> AUTOS ONLY AUTOS
<br /> X AUTOS ONLY X AUOT�S ONL� P�acc dent AMAGE
<br /> UMBRELLA LIAR H OCCUR EACH OCCURRENCE $
<br /> EXCESS LIAB CLAIMS-MADE AGGREGATE
<br /> DED RFTFNTION$ S
<br /> A WORKERS COMPENSATION '( PER OTH-
<br /> AND EMPLOYERS'LIABILITY YIN STAT TE
<br /> ANY PRCPRIETOR/PARTNERIEXECIJTIVE PSWOOO5581 9!1l2025 91112026 1,000,000
<br /> OFFICEE.L.EACH ACCIDENT '
<br /> (Mandatory
<br /> in NH)ER EXCLUDED? Y NIA 11000,000
<br /> If
<br /> in and E.L.DISEASE-EA EMPLOYEE $
<br /> If yes,describe under
<br /> DESCRIPTION OF OPERATIONS helow E.L.DISEASE-POLICY LIMIT $ 1,000,000
<br /> B Professional Liab. PAAEP0102507 91112025 911/2026 Per Claim 2,000,000
<br /> B Professional Liab, PAAEP0102507 9/1/2025 911I2026 Aggregate 4,000,000
<br /> DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached if more space is required)
<br /> All Operations of the Named Insured.
<br /> General Liability:See Additional Insured Endorsement attached;such Coverage is Primary&Non-Contributory with Separation of Insureds and Waiver of
<br /> Subrogation included,as required by written contract.
<br /> Auto Liability: *"Note that the Insured owns no company owned vehicles.* Aforementioned Auto policy includes coverage for Hired&Non-Owned Auto
<br /> Liability only.
<br /> Workers'Compensation:Waiver of Subrogation is included as per attached Waiver of Subrogation Endorsement,as required by written contract.
<br /> Professional Liability includes Waiver of Subrogation,as required by written contract.
<br /> SEE ATTACHED ACORD 101
<br /> CERTIFICATE HOLDER APPROVED CANCELLATION
<br /> =24,Tran Nguyen at 10:40
<br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br /> ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> City of Santa Ana AUTHORIZED REPRESENTATIVE
<br /> Planning and Building Agency
<br /> 20 Civic Center Plaza
<br /> [SantaAna,CA 92701
<br /> ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved.
<br /> The ACORD name and logo are registered marks of ACORD
<br />
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