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AC" CERTIFICATE OF LIABILITY INSURANCE DATE(MM2�ll".� r 2
<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 CONTACT
<br /> NAME: James Santlllan
<br /> Arthur J. Gallagher Risk Management Services, LLC PHONE FAx
<br /> 2050 Main Street A1c No
<br /> Suite 1250 ADOREss: James Santillan a' .com
<br /> Irvine CA 92614 INSURER(S)AFFORDING COVERAGE NAIC#
<br /> License#:OD69293 INSURERA:Hartford Underwriters Insurance Company 30104
<br /> INSURED INSURER B:Employers Preferred Insurance Company 10346
<br /> Carpenter, Rothans & Dumont
<br /> 500 S Grand Ave, Suite 1900 INSURERC:
<br /> 19th Floor INSURERD:
<br /> Los Angeles CA 90017 INSURER E:
<br /> INSURER F
<br /> COVERAGES CERTIFICATE NUMBER:1283172130 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 /> ILTR TYPE OF INSURANCE AODL 5 VD POLICY NUMBER MMI�DYIYYYY M EFF MI��lYYYY LIMITS
<br /> A X COMMERCIALGENERALLIABILITY Y 83SBABH9S5X 2/11/2026 2/1112027 EACH OCCURRENCE $1.000,000
<br /> CLAIMS-MADE � OCCUR DAMAGE TO REN7E0
<br /> PREMISES Ea occurrence $1,000,000
<br /> MED EXP(Any one person) $10,000
<br /> PERSONAL&ADV INJURY $1.000.000
<br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000
<br /> POLICY❑ PRD- ❑ LOC PRODUCTS-CQMPlOPAGG $2,000.000
<br /> X JECT
<br /> OTHER: Deductible s 2,500
<br /> A AUTOMOBILE LIABILITY 83SBABH9S5X 2/11/2026 2/11/2027 COMBINED SINGLE LIMIT S 1,000,000
<br /> Ea acc" "
<br /> ]( ANY AUTO BODILY INJURY(Per person) S
<br /> OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) S
<br /> HIRED NON-OWNED PROPERTY DAMAGE S
<br /> AUTOS ONLY AUTOS ONLY per accident
<br /> s
<br /> A X UMBRELLA LIAB X OCCUR 83SBABH9S5X 2/11/2026 2/11/2027 EACH OCCURRENCE $4,000,000
<br /> EXCESS LJAD CLAIMS-MADE AGGREGATE $4.QD0,000
<br /> DIED I X I RETENTION$ $
<br /> B WORKERS COMPENSATION Y EIG595181600 5/9/2025 5/912026 X SPER
<br /> TATUTE EERH
<br /> AND EMPLOYERS'LIABILITY Y J N
<br /> ANYPROPRIETORIPARTNFRIEXECLITIVE ❑ NIA A E.L.EACH ACCIDENT $1,000,000
<br /> OFFICERIMEMBEREXCLUDED7
<br /> (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $1,000,000
<br /> If yes,describe under
<br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,00❑
<br /> DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES (ACORD lot,Additional Remarks Schedule,maybe attached it more space is required)
<br /> The City of Santa Ana,its officers,officials,employees,and volunteers included as an Additional Insured(s)as respects to General Liability policy,pursuant to
<br /> and subject to the policy's terms,definitions,conditions and exclusions."Except 10 days notice of cancellation for non payment of premium.Waiver of
<br /> Subrogation applies to Additional Insured(s)as respects to Workers Compensation policy,pursuant to and subject to the policy's terms,definitions,conditions
<br /> and exclusions.
<br /> APPROVED
<br /> By Tu Tran Nguyen at 1:08 PM,Mar 09,2026
<br /> CERTIFICATE HOLDER CANCELLATION
<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 /> Attention: City Attorney's Office
<br /> 20 Civic Center Plaza
<br /> Santa Ana CA 92702 AUTHORIZED REPRESENTA IVE
<br /> USA �rC�'\���
<br /> ©1988-2015 ACORD CORPORATION. All rights reserved.
<br /> ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD
<br />
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