CENTURY STRUCTURAL ENGINEERING CO., INC (CSE)

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Digitally signed by Francine Francine R. R. Villareal \ / ; I I v., I Date: 2021.07.30 09:36:40 v i i is i ca i-07'00' ° ,a`oRoCERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 7/26/2021 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER AssuredPartners I Hall & Company A/E Insurance Services 1 Oth Ave NE CONTACT NAME: John Dewing CA License #OK640014 PHONE FAX A/C No Ext: 360-626-2011 AIC, Noy 360-626-2011 E-M19660 ADDRESS: john.dewing@assuredpartners.com INSURER(S) AFFORDING COVERAGE NAIC# Poulsbo WA 98370 INSURERA: Travelers Property Casualty Company of America 25674 INSURED 1273 INSURERB: Hanover Insurance Company 22292 Century Structural Engineering Co Inc 24719 Narbonne Avenue INSURERC: INSURERD: Lomita CA 90717 INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER:435443349 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL INSD SUBR WVD POLICYNUMBER POLICY EFF MM/DD POLICY EXP MM/DD LIMITS A X COMMERCIAL GENERAL LIABILITY 6802H676069 9/20/2020 9/20/2021 EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE OCCUR PREMISES DAMAGE TO PREMISES Ea occurrence) ccurrence $ 1,000,000 MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY PRO- JECT LOC PRODUCTS - COMP/OP AGG $ 2,000,000 $ OTHER: A AUTOMOBILE LIABILITY 6802H676069 9/20/2020 9/20/2021 COMBINED SINGLE LIMIT Ea accident $ 1,000,000 BODILY INJURY (Per person) $ ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ X PROPERTYDAMAGE Per accident $ HIRED X NON -OWNED AUTOS ONLY AUTOS ONLY UMBRELLALIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N PER OTH- STATUTE ER ANYPROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? ❑ N/A E.L. DISEASE - EA EMPLOYEE $ (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ B Professional Liab,Claims Made LH2H69566700 7/24/2021 7/24/2022 Per Claim 1,000,000 Aggregate $2,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) The certificate holder is an additional insured per the attached. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Santa Ana ACCORDANCE WITH THE POLICY PROVISIONS. Risk Management Divison 20 Civic Center Plaza, 4th Floor AUTHORIZED REPRESENTATIVE Santa Ana CA 92702 1 '� Risk MallagementDiviaian C! ,�oRaN�e REVIEWED & APPRQI/ED BY: © 1988-2015 ACORD C z ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD ' Risk Management Analyst