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SCOTFAZ-01 MCCOWANA
<br /> DATE(MMIDDfYYYY)
<br /> CERTIFICATE OF LIABILITY INSURANCE 613/2025
<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 CONTACT Ali Smith
<br /> NAME
<br /> IOA Insurance Services PHONE Ext 619 788-5795 50206 FAx
<br /> 3636 Nobel Drive ( ):( ) {AiC,No):(619)574-6288
<br /> Suite 410 E MAIL
<br /> San Diego,CA 92122 �RESS:AII.Smith@ioausa.com
<br /> INSURERS AFFORDING COVERAGE NAIC it
<br /> INSURER A:RLI Insurance Company 13056
<br /> INSURED INSURER B:Continental Casualty Company 20443
<br /> Scott Fazekas 8,Associates,Inc. INSURER C
<br /> 2 Corporate Park,Suite S-206 INSURER D
<br /> Irvine,CA 92606
<br /> INSURER E
<br /> INSURER F:
<br /> COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: 1
<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 TYpE pF INSURANCE ADDL SE18R p041CY NUMBER POLICY EFF POLICY EXP LIMITS
<br /> A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
<br /> CLAIMS-MADE X OCCUR P5B0003027 615/2025 61512026 DAMAGE TO RENTED 1,000,000
<br /> X X PREMI Es Occurr nee $
<br /> X Limited Cont Liab MED EXP Any one Orson $ 10,000
<br /> X Sery Interest 1 000,000
<br /> PERSONAL&ADV INJURY $ ,
<br /> GEN'LAGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE $ 2,000,000
<br /> F1POLICY® J C D LOG PRODUCTS-COMP/OP AGO $ 2,000,000
<br /> OTHER: Ded 0
<br /> A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,4170 00D
<br /> Ea accident $
<br /> ANY AUTO PSB0003027 615/2025 61512026 BODILY INJURY Perperson) $
<br /> OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY Peraccidenl $
<br /> X HIRED Ix
<br /> NON-OWNED PROPERTY DAMAGE
<br /> AUTOS ONLY AUTOS ONLY Per accident $
<br /> X Autos'Owned
<br /> $
<br /> A X UMBRELLA LIAR X OCCUR EACH OCCURRENCE $ 2,000,000
<br /> EXCESS LIAB CLAIMS-MADE PSEOOOI119 6/512025 61512026 AGGREGATE $ 2,000,000
<br /> ❑ED X RETENTION$ 0
<br /> $
<br /> A WORKERS COMPENSATION X PER OTH-
<br /> AND EMPLOYERS'LIABILITY STAT TE ER
<br /> ANY PRO PRIETORfPARTNERIEXECUTIVE ❑ X YINPSW0001945 6I5I2025 615l2026 E.L.EACH ACCIDENT $ 1,000,000
<br /> OFFICER/MEMBER EXCLUDED? N IA 1,000,000
<br /> (Mandatory in NH) E.L.DISEASE-Eq EMPLOYE $
<br /> If yes,describe under 1,000,000
<br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT
<br /> B Professional Liab. X MCH288352513 6/5/2025 6/512026 Per Claim 2,000,000
<br /> B Ded.:$20k Per Claim X MCH288352513 6/512025 615/2026 Aggregate 2,000,000
<br /> DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
<br /> Re:All Operations
<br /> City of Santa Ana,its officers,employees,volunteers,representatives and agents are Additional Insureds with respect to General Liability per the attached
<br /> endorsement as required by written contract.Insurance is Primary and Non-Contributory.Subrogation applies to General Liability and Workers'
<br /> Compensation and Profess-tonal Liability. TU Tran Digitally slgnedb
<br /> T.Tran Nguyen
<br /> 30 Days Notice of Cancellation with 10 Days Notice for Non-Payment of Premium in accordance with the policy provisions.. Date:mzs.oboa
<br /> Nguyen,4:37:52-07 ee
<br /> APPROVED
<br /> CERTIFICATE HOLDER CANCELLATION By 7u Tran Nguyen at 2,37 pm,Jun 03,2025
<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 /> ISanta Ana.CA 92702
<br /> ACORD 25(2016103) ©1988-2015 ACORD CORPORATION. All rights reserved.
<br /> The ACORD name and logo are registered marks of ACORD
<br />
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