Laserfiche WebLink
PAYOKAA-01 MSOTO2 <br /> Aka:70/2 O CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/VYYY) <br /> 17/11/2025 <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 It0C36861 CONTACT NAME: Anne Krueger <br /> Irvine-Alliant Insurance Services,Inc. (A/CC,,, o,Ea): (949)260-5087 I FAX <br /> 18100 Von Kerman Ave 10th Fl <br /> No): <br /> Irvine,CA 92612 Alt ass'akrueger@alliant.com <br /> INSURERISI AFFORDING COVERAGE NAIC k <br /> INSURER A:Great American E&S Insurance Company 37532 <br /> INSURED INSURER B: <br /> PAYOMKAWICHUM KAAMALAM:THE WESTERNER-FIRST INSURER C: <br /> PEOPLE OF EARTH MOTHER <br /> 4956 PASEO SEGOVIA INSURER D <br /> IRVINE,CA 92603 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 TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS <br /> LTR INSD WVD (MM/DDIYYYY) (MM/DD/YYYY) <br /> A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000 <br /> CLAIMS-MADE X OCCUR X X 214520008 9/29/2025 9/29/2026 PaEreisEs rEa occur°Ace) $ 1,000,000 <br /> X GL DED: $1,000 MED EXP(Any one person) $ 0 <br /> PERSONAL&ADV INJURY $ 2,000,000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 0 <br /> X POLICY 29 LOC PRODUCTS-COMP/OPAGG $ 2,000,000 <br /> OTHER: $ <br /> A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 <br /> fEa accident) <br /> _ ANY AUTO _ x 214520008 9/29/2025 9/29/2026 BODILY INJURY(Per person) $ <br /> OWNED SCHEDULED <br /> AUTOS ONLY UOS AUTOSON BODILY INJURY(Per eccidentQ $ <br /> X AUTOS ONLY x AUTLY (Perr aPcEc Cent)AMAGE <br /> X s;TDODED: <br /> UMBRELLA LIAB _ OCCUR EACH OCCURRENCE $ <br /> EXCESS LIAB CLAIMS-MADE AGGREGATE $ <br /> DED RETENTION$ $ <br /> WORKERS COMPENSATION PER 0TH- <br /> AND EMPLOYERS'LIABILITY Y/N STATUTE FR <br /> ANY <br /> IPROWWMEET RR�/PAR NER/E ECUTIVE N/A E.L.EACH ACCIDENT $ <br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ <br /> If yes,describe under <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ <br /> A NONPROFIT D&O 214520008 9/29/2025 9/29/2026 LIMIT 1,000,000 <br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD let,Additional Remarks Schedule,may be attached if more space Is required) <br /> Additional Insured endorsement attached.Policy form does not contain a General Liability Aggregate.Notice of cancellation will be delivered only to the <br /> participating named insured as stated in the policy.Subject to policy terms,conditions and exclusions. <br /> Carriers on Policy: Digitally signed <br /> Great American-88% Tu Tran by Tu Tran <br /> StarStone Specialty-12% Nguyen <br /> Nguyen Data 2025.11.1e APPROVED '.. <br /> 09:11:59-08'00' <br /> SEE ATTACHED ACORD 101 By Tu Tran Nguyen.at 9:11 am,Nov 18, 292 <br /> I " <br /> CERTIFICATE HOLDER CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> City of Santa Ana THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> ty ACCORDANCE WITH THE POLICY PROVISIONS. <br /> 20 Civic Center Plaza(M-20) <br /> PO Box 1988 <br /> Santa Ana,CA 92702-1988 AUTHORIZED REPRESENTATIVE <br /> ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. <br /> The ACORD name and logo are registered marks of ACORD <br />