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Client#: 25181 PSOMAS <br />DATE (MMIDD/YYYY) <br />ACORD,. CERTIFICATE OF LIABILITY INSURANCE 1 9/10/2019 <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 any rights to the certificate holder in lieu of such endorsement(s). <br />PRODUCER CONTACT <br />NAME: Katie Kresner <br />Greyling Ins. Brokerage/EPIC PHONE FAX J. 866.550.4082 <br />AIC, No, Extj; 770.552.4225 <br />3780 Mansell Road, Suite 370 E-MAIL Katie.Kner re com <br />ADDRESS: <br />res@g Y .iln g• <br />Alpharetta, GA 30022 <br />INSURERS AFFORDING COVERAGE NAIC p <br />INSURER A: National Union Fire Ins. Co. 19445 <br />INSURED INSURER B : <br />Psomas <br />INSURER C : <br />555 South Flower Street; Suite 4300 <br />INSURER D ; <br />Los Angeles, CA 90071 <br />INSURER E <br />INSURER F : <br />rnvGOAr-Ge CFRTIFICATF IdI1MRFR• IQ-9n RFVIRIAN N1IMRFR- <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 />LTR <br />L_& <br />TYPE OF INSURANCE <br />ADDL <br />Ii�iSR <br />U6 <br />WVD <br />POLICY NUMBER <br />POLICY /DD/YY F <br />MM/DD/YYYY <br />POLIffM/DD/ XP <br />MMIDDIYYYY <br />LIMITS <br />A <br />X <br />COMMERCIAL GENERAL LIABILITY <br />CLAIMS -MADE OCCUR <br />5268212 <br />4489706 <br />4/01 /2019 <br />0410112020 <br />EEpAApCCMHHp OCCURRENCE <br />$1 OOO 000 <br />PREIy}f E EoNwwum,rcW <br />$500 000 <br />MED EXP (Any one person) <br />s25,000 <br />PERSONAL & ADV INJURY <br />$1 00O 000 <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />PRO - <br />POLICY FX JECTLOC <br />OTHFR: <br />AUTOMOBILE LIABILITY <br />X ANY AUTO <br />OWNED SCHEDULED <br />AUTOS ONLY X AUTOS <br />HIRED NON -OWNED <br />X AUTOS ONLY AUTOS ONLY <br />GENERAL AGGREGATE <br />s2,000,000 <br />PRODUCTS - COMP/OP AGG <br />s2,000,000 <br />$ <br />A <br />_ <br />4/01/2019 <br />04/01/202 <br />COA'IBINEDSINGLELIMI7dent <br />Ea acc <br />1,000,000 <br />BODILY INJURY (Per person) <br />$ <br />BODILY INJURY (Per accident) <br />$ <br />FROP RTY DAMAGE <br />Per accident) <br />$ <br />$ <br />UMBRELLA LIAR <br />EXCESS LIAB <br />OCCUR <br />CLAIMS -MADE <br />EACH OCCURRENCE <br />$ <br />AGGREGATE <br />$ <br />$ <br />DED RETENTION$ <br />A <br />A <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY <br />ANY PROPRIETORIPARTNER/EXECUTIVEYIN <br />❑FFICE.RIMEM8ER EXCLUDED? FNI <br />(Mandatory In NH) <br />If yes, describe under <br />DESCRIPTION OF OPERATIONS below <br />N I A <br />015893764 (AOS) <br />015893765(CA) <br />4/01/2019 <br />4/01/2019 <br />04/011202a <br />04/01/2020 <br />ER OTH- <br />X I P;TATLITE ER <br />E.L EACH ACCIDENT <br />$1000000 <br />E.L. DISEASE - EA EMPLOYEE <br />$1 00O 000 <br />E.L. DISEASE - POLICY LIMIT <br />$1,000 000 <br />DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required) <br />2SAN051200; Engineering Design Services for Rehabilitation of City Well 29, Agreement No. A-2017-338. The <br />City of Santa Ana, officers, employees, agents & representatives are named as Additional Insureds with <br />respects to General Liability where required by written contract. The above referenced liability policies <br />with the exception of workers compensation are primary & non-contributory where required by written <br />contract. Should any of the above described policies be cancelled by the issuing insurer before the <br />(See Attached Descriptions) <br />[a}galtl:111[WsrlM:L■31111 • <br />By RISK MANAgEMENT UIVI I(OOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />City of Santa Ana THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />Risk Management Division p ACCORDANCE WITH THE POLICY PROVISIONS. <br />20 Civic Center Plaza,4th f1oOy4,EF 9 2019 <br />Santa Ana, CA 92702-0000�211u R}"E❑ REPRESENTATIVE <br />FRANCINE R. VILLAREi��_f� <br />©1988-2015 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2016/03) 1 of 2 The ACORD name and logo are registered marks of ACORD <br />#S1778001 /M 1464737 KKRE1 <br />