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A✓ �® CERTIFICATE OF LIABILITY INSURANCE
<br />DA EIMMIOD/YYY
<br />11I26I2019
<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 Central, Inc.
<br />Pittsburgh PA Office
<br />CONTACT
<br />NAME:
<br />N (8667 283-7122 FAx (8007 363-0105
<br />INC. NR. E.U: NC. No.:
<br />E-MNL
<br />ADDRESS:
<br />EQT Plaza - Suite 2700
<br />625 Liberty Avenue
<br />Pittsburgh PA 15222-3110 USA
<br />INSURER(S) AFFORDING COVERAGE
<br />NAIC•
<br />ED
<br />INSURERA: XL Insurance America Inc
<br />24554
<br />ael Baker international, Inc
<br />tton Centre Drivee 500
<br />INSURER B: Continental Casualty Company
<br />20443
<br />INSURER c:American Casualty Co. of Reading PA
<br />20427
<br />a Ana CA 92707 USA
<br />[SH
<br />INSURER D: Transportation Insurance Co.
<br />20494
<br />INSUflER E Ll Oyd's Syndicate No. 2623
<br />AA1128623
<br />INSURER F:
<br />COVERAGES CERTIFICATE NUMBER: 570079339105 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 />INSIR LT
<br />TYPE OF INSURANCE
<br />pip
<br />yyyp
<br />POLICY NUMBERLIMITS
<br />4
<br />X
<br />COMMERCALGEERAL LABILRY
<br />EACHOCCURRENCE
<br />52.000,000
<br />CLAIMSMADE ❑X OCCUR
<br />PREMISES Ea occurtenre
<br />$1, 000,000
<br />MED EXP Any one Wmil
<br />S10,000
<br />PERSONAL&ADV INJURY
<br />$2,000,005
<br />GE (AGGREGATE LIMITAPPLIES PER:
<br />GENERALAGGREGATE
<br />$4,000,000
<br />POLICY ❑X JEC LOC
<br />FX
<br />PRODUCTS -COMPIOPAGO
<br />$4,000,000
<br />OTHER:
<br />a
<br />AuTomoll VABIL(yy
<br />BUA 6078988680
<br />08/30/201908/30/2020
<br />COMBINED SINGLE MIT
<br />$2,000,000
<br />BODILY INJURY ( Pa, person)
<br />X ANYAUTO
<br />BODILY INJURY (Per acdden0
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />HIREDAUTOS NON -OWNED
<br />PROPERTY DAMAGE
<br />Pet a000Bn1
<br />ONLY AUTOS ONLY
<br />A
<br />X
<br />UMBRELLA LAB
<br />X
<br />OCCUR
<br />IUS0007
<br />52L119A
<br />08 30/2019
<br />087'3672=
<br />EACH OCCURRENCE
<br />$10.000, 000
<br />excess LJAB
<br />CLAIM&MADE
<br />AGGREGATE
<br />$10,000,000
<br />DED I X
<br />IRETEN7KW SLD•DIM
<br />C
<br />WORKERS COMPENSATION AND
<br />wc6078988713
<br />1
<br />TH-
<br />X I PERSTATUTE I OR
<br />EMPLOVERW LMBILITV YIN
<br />E.L. EACH ACCIDENT
<br />$1,000.000
<br />D
<br />ANY PROPRIETOR I PARTNER I EXECUTIVE
<br />EN
<br />N/A
<br />C6078988727
<br />WC6
<br />OB/30/t019
<br />OS/30/2020
<br />E,L. DISEASE -EA EMPLOYEE
<br />$1,000,000
<br />oPFICERReEMeER IXCLUDED?
<br />(M.IMemry In NlO
<br />wI
<br />If YYes, desrke.M,
<br />0 SCRPTION OFOPERATIONS below
<br />EL DISEASE POLICY MIT$1,000,000
<br />E
<br />E&O-PL-Primary
<br />PSDEF1900460
<br />08/30/2019
<br />08/30/2020
<br />Occurence
<br />$5,000.000
<br />Professional & Pollution
<br />Aggregate
<br />S5,000,000
<br />DESCRIPTION OF OPERATIONS ILOCATIONS IVEHICLES (ACORD 101. AtldDlo,al Remarks Scheduw, may W aftwhed It mom .Pace I. nxi.lmd)
<br />For Named Insured Only: Attn: Kim Hartsfield. RE: Project Name: CEpA/NEPA On -call Environmental Services. City of Santa
<br />Anal its officers, agents, employees, volunteers 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
<br />to other insurance available to Additional insured but only in accordance with the policy's provisions. Should General
<br />Professional Liability workers' Compensation be cancelled before the expiration
<br />Liability, Automobile Liability, and policies
<br />date thereof, the policy provisions will govern how notice of cancellation may be delivered to Certificate Holders in
<br />accordance wl th the policy provisions.
<br />CERTIFICATE HOLDER
<br />City of Santa Ana
<br />Risk Management Division
<br />20 Civic Center Plaza, 4th floor
<br />Santa Ana CA 92702 USA
<br />ABOVEF THE POLICIES BE CANCELLED BEFORE THE
<br />R BET EEOF, NOTICEWILLDELIVER
<br />ED RED IN ACCORDANCE WITH THE
<br />POLICY PROVISIONS.
<br />t�E�MS. i �fdlrLd�V 1aQ
<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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