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Client#: 25181 PSOMAS <br />DATE (MMIDD/YYYY) <br />ACORD. CERTIFICATE OF LIABILITY INSURANCE 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 -NAME: Katie Kresner <br />11 Greyling Ins. Brokerage/EPIC PHONE 770.552.4225 AIX Nd; 866.550.4082 <br />A/C No Ext <br />3780 Mansell Road, Suite 370 E-0AIL ae.reser re IIn <br />ADDRESS; Katie. Kn@g y g•tom <br />Alpharetta, GA 30022 INSURER(S) AFFORDING COVERAGE NAIC # <br />INSURER A: National Union Fire Ins. Co. 119445 <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 />rnvconr_oc L`CRTIGICATF MIIMRFR• is -in 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 CONTRACTOR 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 />INSR <br />LTR <br />TYPE OF INSURANCE <br />ADD <br />N <br />UB <br />WVp <br />POLICY NUMBER <br />POLICY EFF <br />DIYYYY <br />POLICY EXP <br />MM/DDIYYYY <br />LIMITS <br />A <br />X <br />COMMERCIAL GENERAL LIABILITY <br />5268212 <br />4/0112019 <br />04/01/202C <br />EACH OCCURRENCE <br />$1 00O 000 <br />PREMISES Ea occur ante <br />$ 500 000 <br />CLAIMS -MADE � OCCUR <br />MED EXP (Any one person) <br />$ 25 000 <br />PERSONAL & ADV INJURY <br />$1,000 000 <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />GENERAL AGGREGATE <br />s2,000,000 <br />PRODUCTS - COMP/OP AGG <br />$2,000,000 <br />PRO- LOC <br />JECT POLICY X <br />$ <br />OTHER: <br />A <br />AUTOMOBILE LIABILITY <br />4489706 <br />4/01/2019 <br />04/01/2020 <br />Co 881 SO$INGLE"LIMIT <br />1,000,000 <br />BODILY INJURY (Per person) <br />$ <br />X ANY AUTO <br />BODILY INJURY (Per accident) <br />$ <br />AUTOS ONLY X SCHEDULED <br />AUTOS <br />X AUTOS ONLY AUTOS ONLY D <br />PROPERTY DAM GE <br />(Per aoladenll _ <br />$ <br />UMBRELLA LIAB <br />OCCUR <br />EACH OCCURRENCE <br />$ <br />H <br />AGGREGATE <br />$ <br />EXCESS LIAB <br />CLAIMS -MADE <br />DED RETENTION $ <br />$ <br />A <br />A <br />WORKERS COMPENSATION <br />ANDEMPLOYERS'EMPLOYERS' LIABILITY <br />ANY PR( YI N <br />OFFICO MEMBER EXCLUDED? NJ <br />(Mandatory In NH) <br />N / A <br />015893764 (AOS) <br />015893765 (CA) <br />4I01/2019 <br />4/01/2019 <br />04/01/202 <br />04101/202 <br />X PER T Ea— <br />E.L. EACH ACCIDENT <br />$1 OOO OOO <br />E.L. DISEASE - EA EMPLOYEE <br />$1 000,000 <br />E,. DISEASE- POLICY LIMIT <br />L <br />$1 OOO OOO <br />If yes, describe under <br />DESCRIPTION OF OPERATIONS below <br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) <br />2SAN410111; Agreement No. A-2014-224; Walnut Pump Station Upgrade Project. The City of Santa Ana, its <br />officers, employees, agents, volunteers & representatives are named as Additional Insureds with respects to <br />General Liability where required by written contract. The above referenced liability policies are primary & <br />non-contributory where required by written contract. Separation of Insureds applies to the General Liability <br />Policy. Waiver of Subrogation is applicable where required by written contract & allowed by law. Should any <br />(See Attached Descriptions) <br />CERTIFICATE HOLDER V1 CV Cx !i+ I +■v�J�n+veLLH1I�Iv <br />By Risk ANACtEMENT DIWISION <br />City of Santa Ana SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />Y THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />Risk Management Division S 19 2019 AC gRDANCE WITH THE POLICY PROVISIONS. <br />20 Civic Center Plaza, 4th flo <br />Santa Ana, CA 92702-0000 IZEDREPRESENTATIVE <br />FRANCINE R. VILLA E <br />,64,6! <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 />#S1778000/M1464737 KKRE1 <br />