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AC®�a CERTIFICATE 4F LIABILITY INSURANCE DATE(MMfDQlYYYY)
<br /> v 1111012028
<br /> THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLYAND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS
<br /> CERTIFICATE DOES NOTAFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND ORALTER 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 David Saechao-RM
<br /> NAME:
<br /> The Liberty Company Insurance Brokers PHONE (888)918-3960 FAX
<br /> A1C Na Ext: Arc No):
<br /> Lic#OD79653 E-MAIL
<br /> A-MAIL : David.Saechao@libertycompany.com
<br /> 5955 Do Soto Ave,Ste 250 INSURER(SI AFFORDING COVERAGE NA[C fF
<br /> Woodland Hills CA 91367 INSURERA: Pacific Employers Ins CO 2274B
<br /> INSURED INSURER B: Great Northern Insurance Company 20303
<br /> TRB and Associates,DBA,TRB and Associates INSURER C: Ace Property&Casualty Insurance Company 20699C
<br /> 3180 Crow Canyon PI.,Ste 216 INSURER D: Chubb National Insurance Company 10052
<br /> INSURER E: U.S.Specialty Insurance Co. 29599
<br /> San Ramon CA 94583 INSURER F:
<br /> COVERAGES CERTIFICATE NUMBER: CL25111006066 REVISION NUMBER:
<br /> THIS IS TO CERTIFY THATTHE 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 ADUL sUdR POLICY EFF POLICY EXP
<br /> LTR TYPE OF INSURANCE INS❑ wVp POLICY NUMBER MM1DDfYYYY MM/DDIYYYY LIMITS
<br /> x COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 2,000.000
<br /> v DAMAGE Tp RFN Ep
<br /> CLAIMS-MADE OCCUR PREMISES Ea ocCurYence 5 1,000,000
<br /> MED EXP{Any one person) $ 5.000
<br /> A Y D03392132 11/10/2025 11/10/2026 PERSONAL&ADV INJURY s 2.000,000
<br /> GEN'LAGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE s 4,000,000
<br /> X POLICY PRO LOC PRODUCTS-COMPIOPAGG 5 4,000,000
<br /> JECT
<br /> OTHER: s
<br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 5 1,000,000
<br /> Ea accident
<br /> X ANYAUTO BODILY INJURY{Per person) S
<br /> B OWNED SCHEDULED Y (25)7365-74-83 11/10122025 11/1012026 BODILY INJURY(Per accident) S
<br /> AUTOS ONLY AUTOS
<br /> HIRED NON-OWNED PROPERTdeY DAMAGE S
<br /> AUTOS ONLY AUTOS ONLY Per accint
<br /> Medical payment s 5,000
<br /> x UMBRELLALIAB OCCUR EACH OCCURRENCE 5 2,000,000
<br /> C EXCESS LIAB HCLAIMS-MADE D03392144 11/10/2025 11/1012026 AGGREGATE 2,000,000
<br /> UED I XJ RETENTION$ 10,000 5
<br /> WORKERS COMPENSATION X STER
<br /> ATUTE ERH
<br /> AND EMPLOYERS'LIABILITY Y I N
<br /> D ANY PROPMFTCRIPARTNERIEXECUTIVE L._._J NIA Y 71815616 12/18/2025 12/18/2026 EL-EACH ACCIDENT S 1,000,000
<br /> OFFICERWEMBER EXCLUDED?
<br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE S 1,O00,000
<br /> It yes,describe under
<br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S 1,000,000
<br /> Professional liability
<br /> per 2,000,000
<br /> E USS2536129 11/10/2026 11110)2026 aggregate 4,000,000
<br /> deductible 25,000
<br /> DESCRIPTION OF OPERATIONS f LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached it more space is required}
<br /> Whereby required by written contract or agreement,City of Santa Ana,its officers,employees,agents and representatives are included as additional insured
<br /> with respect to general liability and auto liability.Insurance is primary and nen-contributory.Waiver of subrogation applies to workers compensation.
<br /> Tu Tran Digitallysigne by
<br /> T.?ran Nguye
<br /> Date:2026.01.
<br /> Nguyen 12:3s:4aa an
<br /> APPROVED
<br /> CERTIFICATE HOLDER CANCELLATION By Tu Tran Nguyen at 12:35pm,Jan 14,202U
<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 /> Planning and Building Agency
<br /> 20 Civic Center Plaza,4th A AUTHORIZED REPRESENTATIVE r
<br /> Santa Ana CA 92701 % /1
<br /> 0 1 988-201 5 ACORD CORPORATION. All rights reserved.
<br /> ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD
<br />
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