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CERTIFICATE OF LIABILITY INSURANCE DATEIMMI6DYYYY)
<br /> a12ar2o2s
<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($).
<br /> PRODUCER CONTACT
<br /> Marsh&McLennan Agency LLC NAME: Jerrod Hughey
<br /> 8144 Walnut Hill Lane, 16th Floor PHONE 972-770-1643
<br /> Fvc N. 972376-8108
<br /> Dallas TX 75231 E-MAIL
<br /> ADDRESS: Jerrod.Hu he MarshMMA,Com
<br /> INSURER S AFFORDING COVERAGE ��29�424
<br /> INSURER A:Hartford Casual Insurance Cam an ENSURED HUITTZDL INSURER Hartford Under-Writers Insurance Company-
<br /> Huitt-ZDllars, Inc. 30104
<br /> 5430 LBJ Freeway, Suite 1500 INSURER Hartford Fire Insurance Company 19682
<br /> Dallas TX 75240 INSURER
<br /> INSURER E;
<br /> i—
<br /> INSURER F;
<br /> COVERAGES CERTIFICATE NUMBER:1835376467 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 SUER POLICY EFF POLICY EXP
<br /> LTR POLICY NUMBER MMIDDIYYYY MMIDDIYYYY LIMITS
<br /> A X /
<br /> COMMERCIAL GENERAL LIABILITY 46UUNOL6HGL 9/12025 9/112026 EACH OCCURRENCE
<br /> I��-x�I $1,000,000
<br /> CLAIMS-MADE �OCCUR DAMAGE TO RENTED
<br /> X Deductible:$D PREMISES Ea occurrence $300,000
<br /> MED EXP(Any one person) 510.000
<br /> PERSONAL&ADV INJURY $1,000,000
<br /> GEN'L AGGREGATE LIMIT APPLIES PER:
<br /> POLICY PRO ® GENERAL AGGREGATE $2,000,000
<br /> JECT LOC
<br /> PRODUCTS•COMPIOP AGG $2,000,000
<br /> OTHER:
<br /> 5
<br /> A AU70MOBFLELIABILITY 46UENOL5276 911/2025 911/2026 COMBINEDSINGLELIM[T
<br /> X ANY AUTO
<br /> Ea accident) $1,000,000
<br /> OWNED SCHEDULED BODILY INJURY(Per person) $
<br /> AUTOS ONLY AUTOS BODLY INJURY(Per accident) $
<br /> HIRED NON-OWNED
<br /> AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE 5
<br /> X Per accident
<br /> Goll$1k1$2k X Camp$lkd$21k $
<br /> A X UMBRELLA X OCCUR 46XHUOL6HJF 91112025 9/1/2026
<br /> EACH OCCURRENCE $10,000,000
<br /> EXCESS LiAB CLAIMS-MADE
<br /> AGGREGATE $10,000.000
<br /> DED X RETENTION$
<br /> 5 g AND EMPS YERS'LSA l 46WEOL6H1G 9/1/2025 9/1/2026 X PER OTH-
<br /> AND EMPLOYERS'LIABILITY YIN .STATUTE ER $0 Deduckrble
<br /> ANYPRDPRIETORIPARTNERIEXECUTIVE E.L.EACH ACCIDENT $1,000Q000
<br /> (Mandatory
<br /> EREXCLUDE67 M NIA
<br /> [Mandatory in NHI
<br /> If yes,describe under E.L.DISEASE-EA EMPLOYEE $1,000,000
<br /> DESCRIPTION OF OPERATIONS below
<br /> E.L.DISEASE-POLICY LIMIT $1,000,000
<br /> G Employee e
<br /> A Hired Car Physical Dam:Pap $i00,000 46UENOL5276 9/1/2025 9/1/2026 Hired i CornplColl Ded$1,0001$1,000
<br /> 4GK3067367125 A Valuable Papers 46UUNOL6HGL 9/112025 9/1/2026 InclpdedenTBPRLimit Limit:$1,000,000
<br /> 9/112025 9/1/2026
<br /> DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (AGORA 101,Additional Remarks Schedule,may be attached if more space is required)
<br /> Additional Insured form#HG0001 edition 09116 applies to the General Liability policy.
<br /> Waiver of subrogation form#H00001 edition 09116 applies to the General Liability policy. Tu Trdn Digitally signed by
<br /> Primary&Non-Contributory General Liability form#H00001 edition 09116. Tu Tran Nguyen
<br /> DateNguyen 10:0820-0'7'0 '
<br /> 09.03
<br /> Additional Insured farm#HA9916 edition 12121 applies to the Automobile Liability policy. �o:as:z3-D7'Do'
<br /> Waiver of subrogation form#HA9916 edition 12121 applies to the Automobile Liability policy.
<br /> Primary&Nan-Contributory Auto Liability form#HA9916 edition 12121. APPROVED
<br /> See Attached... By Tu Tran Nguyen at 10:07 am,Sep 03,2025
<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 /> ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> Attu: Public Works Agency
<br /> CIP/Design Engineering
<br /> 20 Civic Center Plaza M-36 AUTHORIZED REPRESENTATIVE
<br /> Santa Ana CA 92701 �' rr
<br /> 1988-2015 ACORD CORPORATION. All rights reserved.
<br /> ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD
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