|
ACORD Page 1 of 3
<br /> CERTIFICATE OF LIABILITY INSURANCE DATE{MMrOD1YYYY)
<br /> 02J20/2426 HOLDER. THIS
<br /> THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
<br /> CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED ATE
<br /> THE POLICIES
<br /> BELOW, THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURERS}, 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 WTW Certificate Center Willis Towers Watson Insurance Services West, Inc. NAME;
<br /> PHONE . 1--877-945-7378 FAX
<br /> c/o 26 Century Blvd AIC No: 1-8BS-467-2378
<br /> P.O. Box 305191 w ADDRESS, certificates@wtwco,com
<br /> Nashville, TN 372305191 USA
<br /> INSURERS AFFORDING COVERAGE NAIC H
<br /> INSURED INSURER A: National Union Fire Ins Co of Pittsburgh 19445
<br /> Alta Planning + Design, Inc.
<br /> INSURERS: Allied World Insurance Company 22730
<br /> 101 SW Hain St., Ste 2000 INSURERC: AZU Insurance Company 19399
<br /> Portland, OR 97204 INSURER D: Allied World Surplus Lines Insurance Compa 24319
<br /> USA
<br /> INSURER E: At-Hay Specialty insurance Company 19607
<br /> COVERAGES CERTIFICATE NUMBER:w43990279
<br /> 1NSURERF: Travelers Excess & Surplus Lines Company 29696
<br /> 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 INDICATED.
<br /> NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE
<br /> ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF
<br /> SUCH POLICIES. 'LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LIMITS SHOWN ARE INCLUSIVE OF AMOUNTS REQUESTED BY THE CERTIFICATE
<br /> HOLDER AND MAY NOT REFLECT POLICY LIMIT AMOUNTS IN EXCESS OF THOSE REQUESTED. 'Not Applicable in WY
<br /> INSR AODL SUER POLICY EFF POLICY EXP
<br /> LTR TYPE OF INSURANCE POLICY NUMBER MMIODIYYYY MMfDOlYYYY LIMITS
<br /> x COMMERCIAL GENERAL LIABILITY
<br /> EACH GCCURRENCE $ 2,000,000
<br /> CLAIMS-MADE �OCCUR DAMAGE T RENTED
<br /> A PREMISES Ea occurrence $ 2,000,000
<br /> Y Y MED EXP(Any one persun) $ 10,000
<br /> 042670158 12/31/2025 12/31/2026 PERSONAL&ADV INJURY $ 2,000,000
<br /> GEN'L AGGREGATE LIMIT APPLIES PER:
<br /> POLICY PRO GEN ERAL AGGREGATE $ 4,000,000
<br /> OTHER: JECT LOG
<br /> PRODUCTS-COMPIOP AGG 5 4,000,000
<br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
<br /> ANYAUTfl
<br /> (Ea accident) $ 5,000,000
<br /> A OWNED BODILY INJURY(Per person) $
<br /> SCHEDULED Y 042674159 12/31/2425 12/31/2026 BODILY INJURY(Per accident) $
<br /> AUTOS ONLY AUTDS
<br /> HIRED NON-OWNED
<br /> AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE $
<br /> Per accident
<br /> �( UMBRELLALIAB X OCCUR
<br /> B EACH OCCURREN"$5,100',000
<br /> 5,000,000
<br /> EXCESS CLAIMS-MADE 0314-9729 12/31/2025 12/31/2026
<br /> AGGREGATE5,000,000
<br /> OED X RETENTION$10,000
<br /> WORKERS COMPENSATION AND EMPLOYERS'LIABILITY X PER C ANYPROPRIETORlPARTNERIEXECUTIVE YIN STATUTEOFFICEWMEMBER EXCLUDED? ND NIA Y 042670162 12/31f2C25 12/31/2026 E.L.EACH ACCIDE1,000,000(Mandatary In NH)yes,describe under E.L.DISEASE-EA1,000,000DESCRIPTION OF OPERATIONS below
<br /> E.L.DISEASE-PO1,000,000D Professional Liab incl Pollution Y 0313-8987 12/31/2025 12/31/2026 Each Claim Li0,000Policy Aggreg ,000
<br /> DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
<br /> Re: Agreement A-2023-088-14
<br /> SEE ATTACHED
<br /> APPROVED
<br /> By Tu Tran Nguyen at 1:20 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: Public Works Agency, M-36
<br /> CIP/Design Engineering AUTHORIZED REPRESENTATIVE
<br /> 20 Civic Center Plaza
<br /> SANTA ANA, CA 92701 C
<br /> O 1988-2025 ACORD CORPORATION. All rights reserved.
<br /> ACORD 25(2025112) The ACORD name and logo are registered marks of ACORD
<br /> SR ID: 29444336 BATCH: 4332651
<br />
|