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CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDONYYY) 5/8/2018 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPURIANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the PRODUCER Hall & Company A/E Insurance Services 19660 10th Ave NE Poulsbo WA 98370 605 3rd Street Encinitas CA 92024 COVERAGES CERTIFICATE NUMBER: 1350451543 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OFSUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TRI TYPEOFINSURANCE AODC'Sva��--"-'-"--' 1 ! POLICY EFF POLICY EXP POIICYNUMPER ! MM! DIYYYYI MIe IYYYy �4 LIMITS A X COMMERCIAL GENERAL LIABILITY j GLOO14631101 B2012017 ' 812812016 EACH OCCURRENCE 's I coo,000 TOCCUR AMnI;F Efi(Tk^N;E3"�"� CLAIMS -MALE X OOP/XCUIBFPD j MEO EXP (Any one person) $10,ODC X _mea Liability PERSONAL & ADV INJURY _ $ 1,Ga0,000_ I LIMY APPLIES PER: I GENERAL AGGREGATE , �$2,000,000 �G[:1N'LAGGRECaATE POLICY D JEOT ! f LOC PRODUCTS -COMP/OP AGG II $ 2.000,OCO i j OTHER: i i � 3 A 1 AUTOMOBILE LIABILITY X IANY AUTO ( BAP014632901 812812017 i a12,201a t COMBINED SINGLE LIMIT Ea ,S tlA is __ BODILY INJURY (Per person) 4 �DOD.DOD $ ALLOWNED SGHEDULEC 4UTGS FJ AUTOS I 1 BODILY INJURY(Peraccldent) $ X I HIKED AUTOS X I NON-0WNEp I ( aRGPERTY riAM1�'Ai,E AUTOS A X UMBRELLA LIAO XIOCCUR i A00014640701 8/2812017 ' W28COIB EACH OCCURRENCE 51 Do0,006 EXCESS LIAR JII--11 —CLAIM&MADC 1 I ( i AGGREGATE $1 DOD OCO -_.. T''' IX DEC RETE NTIGNSO 1 t� $ A !WORKERS COMPENSATION --{ W0014663001 j 82612017 a28h201a X S4TUZJ 1FR{ AND EMPLOYERS'LIAa1LITP 9i4.„„ wY PROPRIETORAPARTNERIEXECUTIVE AN I GL_CACI I ACCIDENT $1.000,000 EECCLUDED? � N 1 A) lMantla[ory in NHI E L DISEASE EA EMPLOYEE: 51,000 01 l yea, descdhe under •DESCRIPTION OF OPERATIONS be., i E.L. DISFASE-POLICY LIMIT S'U00,000 S i Professional Ups Clams Made ! PECC14691401 ' SnES01 612612016, `s1,000,000 per Clailn I contractors Pallutlnn Lleb'. 00cur I I I I i �' I I I $2,000,000 Aggregate DESCRIPTION OF OPERATIONS I LOCATIONS (VEHICLES FOORD 101, Additional RemarNe Schetlule, may be a0ached If mare space Is rega0ed) Re: Thornton Lake Repairs 4/ The City. Its officers, employees, agents, and representatives are an Addlhonal Insured on the Commercial General UablppI��g Auto Liability wh Squired by written contract or agreement regarding activities by or on behalf of the Named Insured. The Commercial General Lia i 14§sur n e' prima suranca and any other insurance maintained ty the Additional Insured shall be. excess only and non-contributing with this Ins A hro we' rb s n applies to the Commercial General Liability, Auto Liability. Umbrella / Excess Liability and Workers Compensation / Employors lllty 1 V f dttlPJla[ Insured. City of Santa Ana 20 Civic Center Plaza (M-30) P.O. Box 1988 Santa Ana CA 92702-1988 ACORD 25 (2014101) SHOULD ANY OF THE ABOVE DESCRIYI POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS, REPRESENTATIVE Z ;� TION. All rtnhts The ACORD name and logo are registered marks of ACORD