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VIDOSAM-01 JCHRISTIANSON ACaRO� CERTIFICATE OF LIABILITY INSURANCE D 1 1(M MID 29/20Y 1 5 229/2025 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER NA JACT HUB International Insurance Services Inc. Hlc No,Ex1:(949)553-98DD (AA,No 4695 MacArthur Court Suite#600 nM Newport Beach,CA 92660 INSURER IS)AFFORDING COVERAGE NAIC N INSURER A:The Travelers Indemnity Company Of Connecticut 25682 INSURED INSURER B:CorePOlnte Insurance Company 10499 Vida Samarzich,Inc. INSURER C: 515 Cabrillo Park Dr.,Suite 315 INSURER D: Santa Ana,CA 92701 INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLIO EXP LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE �X__ OCCUR X X 4T-CO-A7193762-TCT-26 1/1/2026 11112027 PAEMGETR ISESORENToccED $ 300,000 MED EXP(Afiy one arson 10,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER, GENERAL AGGREGATE 2,000,000 POLICY® jT LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 11000,000 E ac rrt X ANY AUTO X BA-A7193606-26 111/2026 111/2027 BODILY INJURY IParperson) OWNED SCHEDULED _ AUTOS ONLY AUTOS SS1N BODILY INJURY Per accident AUTOS ONLY AU70S ONLY fgeOaccide"I AMAGE UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DFD I I RETENTION$ B WORKERS COMPENSATION AND EMPLOYERS'LIABILITY X PER ETH- ANY AROFRIETORlPARTNERlEXECUTIVE YIN X CPW1004550 1/1/2026 1/112027 E.L.EACH AGOIDENT $ 1,000,000 Q�F@FICERIMEMBEREXCLUOED7 NIA {AAandakory In NH) E.L.DISEASE•EA EMPLOYEE S 1,000,000 If yes,describe under 1,000 000 DESCRIPTION OF OPERATIONS below - E.L.DISEASE-POLICY LIMIT DESCRIPTION OF OPERATIONS/LOCATIONS f VEHICLES (ACORD 101 Additional Remarks Schedule,may be attached If more apace Is required) RE:Project#22-096;On-Call Emergency Asphalt and PPC services for the City of Santa Ana.glaipwvlauwvlwcwv City of Santa Ana,its officers,officials,employees,and volunteers are included as Additional Insureds as respects General Liability per attached endorsement. Dlgltallyslgned This insurance shall apply as Primary and Non-Contributory per attached endorsement. TU Tran byiuiran Waiver of Subrogation for General Liability,Auto Liability and Workers'Compensation:See Attached Endorsements. Nguyen Nguyen Date:2026.01.12 :J 09:37:345-08'00' CERTIFICATE HOLDER CANCELLATION APPROVED -- -f By To Tmn Nguyen at9.V-am-Jan t2,2028- SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE of Santa Ana THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City ACCORDANCE WITH THE POLICY PROVISIONS. 20 Civic Center Plaza(M-30) Santa Ana,CA 92702-1988 AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD