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-� ®DATE(MM/DD/YYYY) <br />A1`* 2_ CERTIFICATE OF LIABILITY INSURANCE <br />08/09/2018 <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. If <br />SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this <br />certificate does not confer rights to the certificate holder in lieu of such endorsement(s). <br />PRODUCER <br />Aon Risk Services Northeast, Inc. <br />Stamford cT office <br />CONTACT <br />NAME: <br />PHONE FAx <br />(AC. No. Ext): (866) 283-7122 A/C.No.): (800) 363-0105 <br />EMAIL <br />ADDRESS: <br />1600 summer street <br />Stamford CT 06907-4907 USA <br />INSURER(S) AFFORDING COVERAGE NAIC # <br />INSURED <br />INSURER A: Peleus Insurance Company 34118 <br />United Testinq LLC <br />INSURER B: Liberty Mutual Fire Ins CO 23035 <br />DBA UNITED-HEIDER INSPECTION GROUP <br />22620 GOLDENCREST DR <br />INSURER C: QBE Insurance Corporation 39217 <br />MORENO VALLEY CA 92553 USA <br />INSURER D: <br />INSURER E: <br />INSURER F: <br />DAMAGE TORENTED $100,000 <br />PREMISES Ea occurrence <br />GOVEKAUES CERTIFIGAIE NUMBER: b/UU(22b2b3nlb 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. Limits shown are as requested <br />INSR <br />LTR <br />TYPE OF INSURANCE <br />ADD <br />INSD <br />SUBR <br />WVD <br />POLICY NUMBER <br />POLICY EFF <br />MMIDD/YYYY <br />POLICY EXP <br />MM/DD/YYYY <br />LIMITS <br />B <br />X COMMERCIAL GENERAL LIABILITY <br />TB Z B J H <br />1 <br />EACH OCCURRENCE $1,000,000 <br />CLAIMS -MADE❑ OCCUR <br />DAMAGE TORENTED $100,000 <br />PREMISES Ea occurrence <br />MED EXP (Any one person) $5,000 <br />PERSONAL &ADV INJURY $1,000,000 <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />GENERAL AGGREGATE $2,000,000 <br />POLICY X❑ PRO F X 1 LOC <br />JECT <br />PRODUCTS - COMP/OP AGG $2,000,000 <br />OTHER: <br />B <br />AUTOMOBILE LIABILITY <br />AS2-Zll-B7386H-018 <br />03/01/2018 <br />03/01/2019 <br />COMBINED SINGLE LIMIT $1,000,000 <br />Ea accident <br />BODILY INJURY ( Per person) <br />X ANYAUTO <br />BODILY INJURY (Per accident) <br />OWNED SCHEDULED <br />AUTOS ONLY AUTOS <br />HIRED AUTOS NON -OWNED <br />ONLYAUTOS ONLY <br />PROPERTY DAMAGE <br />Per accident <br />C <br />X <br />UMBRELLALIAB X OCCUR <br />ccu1317029 <br />03/01/2018 <br />03/01/2019 <br />EACH OCCURRENCE $10,000,000 <br />EXCESS LAB CLAIMS -MADE <br />AGGREGATE $10,000,000 <br />DED I X RETENTION$ 10, 000 <br />B <br />WORKERS COMPENSATION AND <br />EMPLOYERS' LIABILITY <br />ANY PROPRIETOR I PARTNER/ EXECUTIVE — <br />N <br />Wc2Z11B7J86HO48 <br />03/01/2018 <br />03/01/2019 <br />X STATUTE ERH <br />E.L. EACH ACCIDENT $1,000,000 <br />OFFICERIMEMBER EXCLUDED? <br />(Mandatory In NH) <br />N / A <br />E.L. DISEASE -EA EMPLOYEE $1,000,000 <br />If yes, describe under <br />DESCRIPTION OF OPERATIONS below <br />E.L. DISEASE -POLICY LIMIT $1,000,000 <br />A <br />Archit&Eng Prof <br />IAE41973972 <br />06/30/2017 <br />09/15/2018 <br />Aggregate $4,000,000 <br />Each Claim $2,000,000 <br />DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) <br />Re: Agreement Number: A-2016-112 UHIG project No. 10-18102PW Bristol street Widening Project Bristol Avenue Santa Ana, CA 92701 <br />City of Santa Ana its officers, employees, agents and representatives are included as Additional Insured in accordance with the <br />Policy provisions of the General Liability Policy. General Liability Policy evidenced herein is Primary and Non -Contributory to <br />other insurance available to an Additional insured, but only in accordance with the Policy's provisions. A Waiver of Subrogatio <br />is granted in favor of certificate Holder in accordance with the Policy provisions of th eneral Liability Policy. <br />REVIEWED BY: EUNICE HEREDIA (PG) OF ) <br />CERTIFICATE HOLDER <br />CANCELLATION <br />©1988-2015 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE <br />EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE <br />POLICY PROVISIONS. <br />City of Santa Ana <br />AUTHORIZED REPRESENTATIVE <br />20 Civic Center Plaza <br />Santa Ana CA 92701 USA <br />IV. AL. p11Lu1;.4// � .I��sa <br />©1988-2015 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD <br />