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A " CERTIFICATE OF LIABILITY INSURANCE
<br />DATE(MML0
<br />0Srz412U18 16
<br />1
<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, khe pollcy(ias) must have ADDITIONAL INSURED provisions or ba 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 />ADD Risk Services Central, Inc.
<br />Pittsburgh PA Office
<br />EST Plaza - Suite 2700
<br />625 Liberty Avenue
<br />Pittsburgh PA 15222-3110 NSA
<br />CONTACT
<br />NAME;
<br />NC. N'pOS .ED: (E D: 865) 283-7122 FAX,Noh (800) 363-0105 mm
<br />I
<br />EMAIL
<br />ADDRESS:
<br />INSURERS) AFFORDING COVERAGE
<br />NAIC#
<br />INSURED
<br />Michael Bake l' International, Inc
<br />5 Hutton Centre Drive
<br />suite 500
<br />INSURERA: Liberty Mutual Fire Ins CO
<br />23035
<br />INSURER B: Liberty Insurance Corporation
<br />42404
<br />INSURER C: Lloyd's Syndicate No. 2633
<br />Ag1128623
<br />Santa Ana CA 92707 USA
<br />INSURER D; XL Insurance America Inc
<br />24554
<br />NSURER E;
<br />INSURER F:
<br />COVERAGES CERTIFICATE NUMBER: 570072755845 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. Units shown are as requested
<br />LTR
<br />TYPE OF INSURANCE
<br />INSC
<br />Me
<br />POLICYNUMBER
<br />M ODNYYY
<br />EXP
<br />MMI��I"
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE M OCCUR
<br />TS 1004145718
<br />General Liability
<br />08/30/Z018
<br />08/30/2019EACH
<br />OCCURRENCE.
<br />$2,000,000
<br />M G r RiNTEO
<br />PREMISEB Ea occunence
<br />1300,000
<br />_
<br />MED EXP(Any one person)
<br />$10,000
<br />m
<br />PERSONAL&ADVINJUY
<br />$2,000,000
<br />GEN'LAGGREGATE LIMITAPPLIES PER:
<br />POLICY X PRO- X LOG JECT
<br />GENERALAGGREGATE
<br />$4, 000,000
<br />PRODUCTS -CONFIDE AGO
<br />$4,000,000
<br />OTHER:
<br />A
<br />AUTOMOBILE LIABILITY
<br />A52-681-004145-728
<br />Commercial Auto - ADS
<br />08/30/201808/30/2019
<br />COMBINED SINGLE LIMIT
<br />L n;denu
<br />$2,000,OQO
<br />BODILY INJURY (Per person)
<br />U-'
<br />X ANYAUTO
<br />OWNED SCHEOIJLEp
<br />AUTOS ONLY AUTOS
<br />BODILY INJURY (Per ecdden0
<br />'-"—_--
<br />PROPERTY DAMAGE
<br />Per ar.d.m)
<br />HIRCDAUTOa NON -OWNED
<br />ONLY AUTOS ONLY
<br />D
<br />X
<br />UMBRELLAUA9
<br />EXCEs. LIAR
<br />X
<br />OCCUR
<br />CLAIMS -MADE
<br />7000799521-118A
<br />Nalb Pella
<br />08/30/2018
<br />08/30 2019
<br />EACH OCCURRENCE
<br />$10,000,000
<br />AGGREGATE
<br />$10.000,000
<br />DED X RETENTION SO 000
<br />e
<br />WORKERS COMPENSAI ION AND
<br />EMPLOYERS'LIABILITY
<br />ANY PROPRIETOR I PAWNER I EXECUTIVE YIN
<br />OFFICEwMEtABER EXCLUDED? 17,
<br />(Mandatary In NH)
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />NIA
<br />WA768DO04145778
<br />Workers come �- ADS
<br />08/30/2018
<br />08 30/2019
<br />PER OTH-
<br />X BTATUTE E
<br />E. L. EACHACCIDENT_
<br />$1,000,OQO
<br />E. L. DISEASE -EA EMPLOYEE
<br />_
<br />$1,000,000
<br />E. L. DISEASETCABY LIMIT
<br />_ _
<br />$1,000,000
<br />c
<br />E&O-PL-Primary
<br />PSDEF1800460
<br />Professional Lib. and CP
<br />08/31/20JB
<br />08/30/2019
<br />Per Claim
<br />Aggregate
<br />$5,000,000
<br />$5.000,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additlohal Remarks Schodulo, army be ouached if more apace le reryuired)
<br />For Named Insured Only: Attn: Kim Hart5field, RE: Project Name: CEQA/NEPA On -Call Environmental Services, City Of Santa
<br />Ana, its officers, agents, employees, volunteers and representatives are included 15 Additional insured in accordance with the
<br />policy provisions OF the General Liability policy, General Liability policy evidenced herein is Primary and Nan -Contributory
<br />to other insurance available to Additional Insured, but only in accordance with the p01icy's provisions. Should General
<br />Liability, Automobile Liability, Professional Liability and Workers' compensation policies be cancelled before the expiration
<br />date thereof-, the policy provisions will govern how notice of cancellation may be delivered to certificate Holders In
<br />accordance with the policy provisions.
<br />CERTIFICATE HOLDER CANCELLATION
<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 AUTHORIZED REPRESENTATIVE--
<br />Attn: EXeCUtiVe Director
<br />20 Civic Center Plaza (M-20)
<br />Santa Ana CA 92702 USA r. /� �je/ 7/L ICk'd 92 ELEG (uT^Zd
<br />P
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<br />91988•2015 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
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