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(MMIDDITTYI
<br />AFRO CERTIFICATE OF LIABILITY INSURANCE DnT5/3/2019 )
<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 endomement(s).
<br />PRODUCER CONTACT
<br />Hall & Company PHONE Allison Barga Licesnse#OK93926 FAX _-
<br />A/E Insurance Services AA/CNo.Ext): 360-626-2007 to)c Not: 360-626-2007
<br />19660 10th Ave NE E-MAIL ---
<br />ADDRESS;barga@hallan adcornpanycom._
<br />PoulsboWA98370 INSURER(S)AFFORDINGCOVERAGE NAIC4
<br />INSURER A: Zurich American Insurance Company 16535
<br />INSURED 25
<br />Dudek INSURERS Steadfast Insurance Company 26387
<br />605 3rd Street I INSURE RC
<br />Encinitas CA 92024 INSURERD
<br />CO\/FRAr;FS nFeTIDIr.ATF NI IIIIIRFD• 1 l acn n co00 ocnclr�u
<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 />INTRR
<br />TYPE OF INSURANCE
<br />ADD(SU9R
<br />POLICY NUMBER
<br />POLICY SEE
<br />MMIDDIYYYY
<br />POLICY EXP
<br />MM/ODIYYYY
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE OCCUR
<br />_ _ /BFPD _
<br />GLOO14631102
<br />8/28/2018
<br />8/28/2019 EACH OCCURRENCE $1,000,000
<br />I DAMAGE TO RE TED
<br />1 PREMISES( a. occurrence) $ 100,000
<br />X
<br />X
<br />....
<br />1
<br />Cross LiabilityPERSONAL
<br />& ADV INJURY $ 1,000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />POLICY �X] JECT LOG
<br />GENERAL AGGREGATE $2,000,000
<br />PRODUCTS-COMP/OPAGG $2,000,000
<br />OTHER'.
<br />$
<br />A
<br />AUTOMOBILE
<br />LIABILITY
<br />BAP014632902
<br />8/28/2018
<br />8/28/2019
<br />'I COMBINED tSINGLE LIMIT
<br />$1,000,000
<br />ANY AUTO
<br />BODILY INJURY (Per person)
<br />$
<br />OWNED r SCHEDULED
<br />AUTOS ONLY 'AUTOS
<br />BODILY INJURY Per accident
<br />( )
<br />$
<br />PX
<br />HIRED Xy NON -OWNED
<br />AUTOS ONLY AUTOS ONLY
<br />I
<br />1,
<br />PROPERTY DAMAGE
<br />Per accident
<br />$
<br />$
<br />A '', X I UMBRELLALIAB X I OCCUR
<br />AUC014640702 8/28/2018
<br />8/28/2019
<br />EACH OCCURRENCE
<br />$1,000,000
<br />AGGREGATE
<br />_
<br />$ 1,000,000
<br />I$
<br />EXCESS LIAB '_ CLAIMS -MADE
<br />I,
<br />DED X RETENTION$ I,
<br />_ _
<br />A
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY YIN
<br />ANYPROPRIETOR/PARTNER/EXECUTIVE
<br />OFFICER/MEMBER EXCLUDED? NIA
<br />WC014633002
<br />8/28/2018 ''. 8/2812019
<br />X PER OTH-
<br />—_ STATUTE ER
<br />E.L. EACH ACCIDENT
<br />$ 1,000,000
<br />E.L.DISEASE - EA EMPLOYEE'',
<br />-
<br />S1,000,000
<br />(Mandatory (Mandatory In NH)
<br />f yes, describe under
<br />E.L. DISEASE -POLICY LIMIT
<br />-
<br />"' S 1,000,000
<br />DESCRIPTION OF OPERATIONS be
<br />e
<br />Professional Had Claims Made
<br />Contractors Pollution Job: Occur
<br />1
<br />PECO14831402
<br />8/28/2018
<br />8/28/2019 $1,000,000 Per Claim
<br />$2,000,000 Aggregate
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required)
<br />Re: Thornton Lake Repairs - N-2018-106
<br />The City, its officers, employees, agents, and representatives are an Additional Insured on the Commercial General Liability an Auto Liability w n required by
<br />written contract or agreement regarding activities by or on behalf of the Named Insured. The Commercial General Liability in cc is prima surance and
<br />any other insurance maintained by the Additional Insured shall be excess only and non-contributing with this insurance. A 11�,,i er of subrog n applies to the
<br />Commercial General Liability, Auto Liability, Umbrella / Excess Liability and Workers Compensation /Employers Liabili.11, Wor of the A Itional Insured.
<br />�T✓S /�yV
<br />CFRTIFICATF Hni OOP nAKlrRl I ATlnkl v r �a..M.n
<br />SHOULD ANY OF THE ABOVE DES
<br />SEY[SIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THE
<br />OF,-fJ.-Qf, �. WILL BE DELIVERED IN
<br />City of Santa Ana
<br />20 Civic Center Plaza (M-30)
<br />ACCORDANCE WITH THE POD PROVI44`IbYJS.
<br />AUTHORIZED�TORIRII,Z�,ED REPRESENTATIVE
<br />(' / .Z, 7
<br />P.O. Box 1988
<br />Santa Ana CA 92702-1988
<br />l9J louts-ZU1D ACUKU CORPURATION. All rights reserved.
<br />ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD
<br />
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