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Last modified
6/26/2026 4:21:00 PM
Creation date
6/26/2026 4:20:56 PM
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Contracts
Company Name
PSOMAS
Contract #
A-2023-088-06A
Agency
Public Works
Council Approval Date
5/16/2023
Expiration Date
5/15/2027
Insurance Exp Date
4/2/2027
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CERTIFICATE OF LIABILITY INSURANCE °ATE`r'Mr°°"YYY' <br /> 31 1 7120 2 6 <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 0NTeACT Gre lin COI Specialist <br /> Edgewood Partners Ins Center PHONE 770,750.8549 FAX Net- <br /> ADDRESS: 770.75&.6599 <br /> 3780 Mansell Rd.Suite 370 <br /> Alpharetta GA 30022 Ore tin carts re tin .com <br /> INSURERS AFFORDING COVERAGE NAIC9 <br /> INSURER A:National Union Fire Ins Cc of Pittsbur 14445 <br /> INSURED INSURER B: <br /> Psornas <br /> 865 South Figueroa Street INSURERC: <br /> Suite 3200 INSURER 0 t <br /> Las Angeles CA 90017 <br /> INSURER E: <br /> INSURER F: <br /> COVERAGES CERTIFICATE NUMBER:1522473404 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 /> INBR TYPE OF INSURANCE ADOL SUERI <br /> POLICY EFF POLICY EXP <br /> LTR POLICY NUMBER F— <br /> I(&IWDDNYYYI MMIDOIYYYY LIMITS <br /> A X. COMMERCIAL GENERAL LIABILITY OLS268212 10112025 4/112027 EACH OCCURRENCE S2,000,000 <br /> CLAIMS-MADE MOCCUR DAMAGE TO RENTEO <br /> PREMISES Ea eccurr.ncal 5500,000 <br /> MEP EXP(Any one person) 525.000 <br /> PERSONAL&ADV INJURY $2,000,000 <br /> GENL AGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE $4,000,000 <br /> POLICY[K JEC El LOC PRODUCTS-COMP(OPAGG $4,000.000 <br /> OTHER: 5 <br /> A AUTOMOBILE LIABILITY CA4489706 4/112026 411/2027 Ee lad aISINGLELIMIT 52,000,000 <br /> IX <br /> ANYAUTO BODILYINJURY(Parpersun) s <br /> OWNED AUTOSCHEOUL60BODILY INJURY Per eccidani. S <br /> AU70S ONLY AUTO5 I }HIRED N NON-OWNEDPROPERTY DAM1IAGEAUTOS ONLYAUTOS ONLY Par accident S <br /> S <br /> UMBRELLALIAB OCCUR EACH OCCURRENCE S <br /> EXCESS LLAB Id CLAWS-MADE <br /> AGOREOATE 5 <br /> DED I I RETENTIONS S <br /> A W KERS COMPENSATION <br /> WC72113158(AOS) 411/2026 11112121 X 5TATLITE ER <br /> ANYPROPRrETORIPARTNERIEXECUTIVE ❑YIN WC72113159{CA) 411/2026 g1112027 - <br /> OFFICERIMEMSEREXCLUDED? NrA E.L.EACH ACCIDENT E.L.D15EAS 52,000,000 <br /> (Mandatory In Ni E-EA EMPLOYE 52,00o,000 <br /> If pas,describe under - <br /> DESCRIPTIONOFOPERATIONSbeluw E.L-DISEASE.POLICY LIMIT 52,000.000 <br /> DESCRIPTION OF OPERATIONS I LOCATIONS r VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space 11 required) <br /> 2SAN051701;Santa Ana Agreement for RFP A-2023-075-07 On-call Engineering Services. <br /> City of Santa Ana its officers,officials,employees,and volunteers are named as Additional Insureds with respects t0 General&Automobile Liability where <br /> required by written contract.The above referenced liability policies are primary&non-cantributory where regUIred by written contract.Waiver of Subrogation in <br /> favor of Additional Insured(s)where required by written contract&allowed by law.Should any of the above described policies be cancelled by the Issuing <br /> insurer before the expiration date thereof,we will endeavor to provide 30 days'written notice(except 10 days for nonpayment of premium)to the Certificate <br /> Holder. <br /> APPROVED <br /> CERTIFICATE HOLDER CANCELLATION ByTU Fran Nguyen at 11:54am,Apr06,202G <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 /> Public Works Agency <br /> Santa Ana CA 92702-1988 AUTHORIZED REPRESENTATIVE <br /> / <br /> 16- <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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