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.II FFFNf:_n'I <br />VI Muir: <br />,441C-oRJiT CERTIFICATE OF LIABILITY INSURANCE <br />`-� <br />OATE(MMIDD YYYY) <br />8 /2 112 0 1 8 <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 License # OE67768 <br />ICA Insurance Services <br />3875 Ho yard Road <br />Suite 200 <br />CONTACT Gigi Yuen <br />PHONE FAX <br />(A/c, No, Ext): (925) 660-3514 50008 AIC, No:(925) 416-7869 <br />aooR S: Gigi.Yuen@ioausa.com <br />Pleasanton, CA 94588 <br />INSURERS AFFORDING COVERAGE <br />NAIC a <br />INSURER A: Travelers Property Casualty Company of America <br />25674 <br />09/0112019 <br />INSURED <br />JLee Engineering, Inc. <br />INSURERB:Arch Insurance Company <br />11150 <br />INSURERC: <br />INSURER D: <br />430 S. Garfield Avenue, #301 <br />Alhambra, CA 91801 <br />INSURER E <br />INSURER F: <br />PERSONAL&ADV INJURY $ 2'000,000 <br />rf1VPRAC:CS rCRTICIr ATC IUI Mel OCtrIC1r1M MI IMIGCO. <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 <br />TYPE OF INSURANCE <br />ADDL <br />SUBR <br />POLICY NUMBER <br />POLICY EFF <br />POLICY EXPJJJL <br />LIMITS <br />A <br />X COMMERCIAL GENERAL LIABILITY <br />CLAIMS -MADE OCCUR <br />6802H013864� <br />09/01/2018 <br />09/0112019 <br />EACH OCCURRENCE 2'000,000 <br />DAMAGE TO RENTED $ jrgggrggg <br />MED EXP (Any oneperson) 10,000 <br />PERSONAL&ADV INJURY $ 2'000,000 <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />POLICY [XI 5E ROT [:] LOC <br />GENERALAGGREGATE $ 4'000'000 <br />PRODUCTS-COMP/OP AGO li 41000'000 <br />OTHER: <br />/{ <br />AUTOMOBILE <br />LIABILITYEa <br />COMBINED SINGLE LIMIT 2000 000 <br />acciden <br />BODILY INJURY Per erson $ <br />AUTO <br />6802HO138641/ <br />09/01/2018 <br />09/01/2019 <br />IxANY <br />OWNED SCHEDULED <br />AUTOS ONLY AUTSSW <br />OS <br />BODILY INJURY Per accident $ <br />PeOPEIR nPAMAGE <br />p <br />AUTOS ONLY X AUTOS ON V <br />UMBRELLA LIAR <br />OCCUR <br />EACH OCCURRENCE $ <br />AGGREGATE $ <br />EXCESS LRB <br />CLAIMS -MADE <br />DED RETENTION$ <br />A <br />WORKERS COMPENSATION <br />ANO EMPLOYERS' LIABILITY YIN <br />ANY PROPRIETOERR/PARTNER/EXECUTIVE <br />?hiaodffioryin NH) EXCLUDED? <br />N /A <br />UB3J84391A✓ <br />09/0112018 <br />09101/2019 <br />X SPERTATUTE OTH <br />E.L. EACH ACCIDENT $ 1,000,000 <br />E.L. DISEASE -EA EMPLOYE $ 1,000,000 <br />If yes, describe under <br />DESCRIPTION OF OPERATIONS below <br />E.L. DISEASE - POLICY LIMIT 1,000,000 <br />B <br />Professional Liab. <br />PAAEP00102500 <br />09/01/2018 <br />09/01/2019 <br />Per Claim 1,000,000 <br />B <br />Professional Liab. <br />PAAEP00102500 <br />09/01/2018 <br />09/01/2019 <br />Aggregate 1,000,000 <br />DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) <br />All Operations of the Named Insured. <br />General Liability: See Additional Insured Endorsement attached; such coverage is Primary & Non -Contributory and includes Separation of Insureds, as <br />required per written contract. <br />NOTE: No company-owned vehicle. General Liablity includes coverage for Hired & Non -Owned Auto Liability. <br />GENERAL LIABILITY ADDITIONAL INSURED INCLUDES THE FOLLOWING PERSON(S) OR ORGANIZATION(S): City of Santa Ana, its officers, employees, and <br />agents <br />CANCELLATION NOTICE: 30 days written notice is provided to the aforementioned Certificate Holder. <br />City of Santa Ana <br />Attn: Planning Department <br />20 Civic Center Plaza <br />wrnon c r,n�cmam <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />AUTHORIZED REPRESENTATIVE <br />p w l <br />n.rnoo nnac cannon rnoono wrrnu wu _._�. <br />The ACORD name and logo are registered marks of ACORD <br />