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<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 bo
<br />endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A
<br />statement on this certificate does not confor rights to the certificate holder In Ile of such a ndorsementfsl.
<br />PRODUCER
<br />Aon Risk Services, Inc or Florida
<br />1001 Erickall Bay Drive, Suite #1100
<br />Miami, FL 331314937
<br />0380
<br />AGE TofidSouroe DE. IV, Inc,
<br />1020D &onset Drive
<br />Miaml, FL 33173
<br />Door
<br />INSURER
<br />Keyser Marston AssSuit.4, Inc, INSURER E:
<br />1299 Fourth Street, Salta 408
<br />Sqn Rofea, CA 94941 � F.
<br />INSURER
<br />COVERAGES CERTIFICATE NUMBER- 187a4R3 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 />EXCLUSIONSAND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LIMITS SHOWNARE AS REQUESTED.
<br />INSIR
<br />LTR
<br />TYPE OF INSURANCE
<br />ADDLSUBR
<br />INSR
<br />WVO
<br />POLICY NUMBER
<br />POLICY EFF
<br />MMID@YYYY
<br />POLICY EXP
<br />MMPoOIYYYY
<br />LIMITS
<br />COMMERCIAL GENERAL LIABILITY
<br />CLAWS -MADE 7 OCCUR
<br />EACH OCCURRENCE
<br />$
<br />DAMAGE TO
<br />S(RENTED
<br />PREMISES RENT rrenGe)
<br />$
<br />MED EXP (Any one arson
<br />$
<br />PERSONAL &ADV INJURY
<br />$
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />POLICY ❑ PROJECT LJ LOC
<br />OTHER
<br />GENERAI.AGGREGATE
<br />$
<br />PRODUCTS � COMP/OP AGO
<br />$
<br />$
<br />AUTOMOBILE
<br />LIABILITY
<br />ANYAUTO
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />HIRED NONI
<br />AUTOS ONLY AUTOS ONLY
<br />COMBINED SINGLE I
<br />Ea accldeni
<br />$
<br />BODILY INJURY Par parson
<br />$
<br />BODILY INJURY Per accident
<br />$
<br />PROPERTY DAMAGE
<br />Poraccldent
<br />$
<br />UMBRELLA LIAB
<br />EXCESS LIAB
<br />HOCCUR
<br />CLAIMS -MADE
<br />EACH OCCURRENCE
<br />$
<br />AGGREGATE
<br />$
<br />DEC I I RETENTION
<br />$
<br />A
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY YIN
<br />ANY PRCPRIF.TORIPARTNER/EXECUTNE
<br />OFFICER/MEMBER EXCLUDED?
<br />(Mandatory In Nllf
<br />Ityoe, J,6.Ibeueder
<br />DESCRIPTION OF OPERATIONSlow be
<br />N/A
<br />X
<br />WC 026181717 CA
<br />01/01/18
<br />07/01/'18
<br />X PER OTH
<br />PTATUTF. ER
<br />E. L. EACHACCIDEM
<br />$ 2,000,000
<br />E. ,DISEASE -EA EMPLOYEE
<br />$ 2,000,000
<br />E.L, DISEASE - POLICY LIMIT
<br />$ 2, DDD,UDD
<br />DESCRIPTION OP OPERATIONS LOCATIONS I VEHICLES (ACORD 101, Additional Remarks auhadule, maybe attached if more space Is repaired)
<br />Sae attached Dedicate Holder Cancellation Notice.
<br />All worksite employees working for KEYSER MARSTON ASSOCIATES, INC., paid under ADP TOTALSOURCE, INC's payroll, are covered under the above stated policy,
<br />WAIVER OF SUBROGATION IN FAVOR OF CITY OF SANTA ANA ITS OFFICERS, OFFICIALS, EM PLOYEEG AGENT, REPREE NTATIVES AND VOLUNTEERS AS RESPECTS OF JOB PERFORMED BY
<br />KEYSER MARSTON ASSOCIATES, INC. AS REQUIRED BY WRITTEN CONTRACT,
<br />CERTIFICATE HOLDER CANCELLATION
<br />City of Santa Ana
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />Executive Dlrectar of ODA
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />20 Civic Center Plaza M45
<br />Santa Ane, CA 92701
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />AUTHORIZED REPRESENTATIVE
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<br />©1988.2016 AGORD CCRPORATI0 N, All rights reserved.
<br />ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD
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