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AG t) CERTIFICATE OF LIABILITY INSURANCE
<br />05128/2019YY)
<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 endorsement(s).
<br />PRODUCER LIC #OE28842 1-949-756-4100
<br />Invensure Insurance Brokers, Inc.
<br />17991 Cowan
<br />CONTACT T Kathryn Lopez
<br />NAME:N.
<br />L81),949-756-412ve3 FpAX No: 949-756-4199
<br />E-MAIL klo ez@innsure. corn
<br />AOORE55: H
<br />INSURERS AFFORDING COVERAGE
<br />NAIC#
<br />Irvine, CA 92614
<br />INSURERA: LIBERTY NUT FIRE INS CO
<br />23035
<br />INSURED
<br />EBB General Engineering, Inc.
<br />INSURER B: FIRST LIBERTY INS CORP
<br />33588
<br />INSURER C : LIBERTY INS CORP
<br />42404
<br />INSURER D:
<br />1320 E. Sixth St, #100
<br />INSURER E :
<br />Corona, CA 92879
<br />INSURER F:
<br />COVERAGES CERTIFICATE NNMRER• 56263086 OaTNmnu nil MBER. _
<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 />ILTR
<br />TYPEOFINSURANCE
<br />ADOL5
<br />BR
<br />POLICY NUMBER
<br />FF
<br />PWDDNYFF
<br />ME
<br />POLICYEXP
<br />MML1C YYYY
<br />LIMITS
<br />A
<br />X
<br />I COMMERCIALGENERALLIABILITY
<br />CLAIMS -MADE F7X OCCUR
<br />X
<br />TB2-Z91-454286-018
<br />09/28/18
<br />09/28/3-9
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />DAMAGE TO RETT—ED
<br />PREMSES(E. occurrance
<br />—
<br />$ 100,000
<br />X
<br />MED EXP (Any one person)
<br />$ 5,000
<br />$2,500 Deductible
<br />PERSONAL B ADV INJURY
<br />$ 1,000,000
<br />AGGREGATE LIMIT APPLIES PER:
<br />POLICY � BE� 1-1 LOC
<br />GENERALAGGREGATE
<br />$ 2,000,000
<br />GENT
<br />PRODUCTS - COMPlOP AGG
<br />$ 2,000,000
<br />$
<br />OTHER:
<br />B
<br />AUTOMOBILE
<br />LIABILITY
<br />A86-Z91-454286-028
<br />09/28/18
<br />09/28/19
<br />COMBINED SINGLE LIMIT
<br />_ Ea accident
<br />$ 1,000,000
<br />X
<br />ANYAUTO
<br />BODILY INJURY (Per person)
<br />$
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />BODILY INJURY (Per accident)
<br />— ---
<br />IS
<br />X
<br />HIRED
<br />AUTOS ONLY X AUTOS ONLDV
<br />PROPERTY DAMAGE
<br />-(Per accR ru l
<br />$
<br />_
<br />C
<br />X
<br />DMBRELLALIAB
<br />X
<br />OCCUR
<br />TH7-Z91-454286-048
<br />09/28/18
<br />09/28/19
<br />EACFI OCCURRENCE
<br />$ 4,000,000
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />AGGREGATE
<br />$ 4,000,000
<br />DED RETENTION$
<br />$
<br />B
<br />WORKERS COMPENSATION
<br />ANDENIPRIETORPART EMITY YIN
<br />ANYICERUMETORJPARTNE(UE%ECUTIVE
<br />OEEICEtuq
<br />NIA
<br />WC2-Z91-454286-038
<br />09/28/18
<br />09/28/19
<br />X STATUTE ERH
<br />ELEACHACCIDENT
<br />$ 1,000,000
<br />E, L. DISEASEEAEMPLOYEE
<br />-
<br />$ 1,000,000
<br />In NERE%CLUDED4
<br />0 yes, describe
<br />Ityes,dorybeund
<br />EL.DISEASE-POLICY LIMIT
<br />J$ 1,000,000
<br />OF O
<br />DESCRIPTION OF OPERATIONS below
<br />DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD Im, Additional Remarks Schedule, may be attached it more space is required)
<br />Primary wording CO 20 01 04 13 applies per attached form.
<br />Certificate holder"+ in additional insured per attached CG 2010 04 13 and CO 2037 04 13,
<br />**City of Santa Ana is additional insured.
<br />Projects PROJECT NOS. 18-7526, 18-7527 & 18-6910; RESIDENTIAL STREET REPAIR PROGRAM AND ALLEY
<br />IMPROVEMENT FY17/18 PROJECT
<br />EBB Job #19063
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />City of Santa Ana THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />Management I ACCORDANCE WITH THE POLICY PROVISIONS.
<br />0 Civic Center Plaza AUTHORIZED REPRESENTATIVE
<br />Ana, CA 92702 p /7
<br />I USA ,�e-r� (/-u y-
<br />988-2015 ACORD CORPORATION. All
<br />ACORD 25 (2016I03) The ACORD name and logo are registered marks of ACORD
<br />klopez
<br />56263086
<br />
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