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4CC?Rp� CERTIFICATE OF LIABILITY INSURANCE <br />DATE(MMIDDIYYYY) <br />V IFJILVCU <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS <br />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($), <br />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 <br />PmAslons or be endorsed. <br />If SUBROGATION IS WAIVED, subject to the terms and conditions of the Polley, cerfaln polices may require an endorsement. <br />A statement on <br />this certificate does not confer rights to the certificate holder in lieu of such 0 dorsoment(s). <br />PRODUCER <br />Marsh USA Ic. n <br />CONTACT <br />N <br />Minneap lis, MN 5e4 2240000 <br />PHONE <br />-(BrG.B xo VAX o: <br />E-MAIL <br />A REB <br />IN9URER(e)AFFORDINe CgVERAGE <br />NAICry_ <br />99309-ILBR-GAWX-20-21 <br />IINSURED <br />NSURE <br />INsuRERA Llbertv Mutual Flre Ins Co <br />23035 <br />International620 Line Builders <br />INsuRERa-NIA <br />_N/A <br />2520Rubidoux Blvd. <br />PO Box 3039 <br />__ <br />mauRER c; Libetl InsurenceC ration <br />42404 <br />INSURERo: <br />RIYErall CA 92609 <br />INSURER E <br />COVERAGES CFaTlalr n•re unnao em. <br />N9URER F: <br />__. <br />--- ------ •-•• Onruw•weueo-ui <br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED <br />KEVISION NUMBER: <br />NAMED ABOVE FOR THE POLICY PERIOD <br />INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER <br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED <br />DOCUMENT WITH RESPECT TO WHICH THIS <br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED <br />HEREIN IS SUBJECT TO AL <br />L THE TERMS, <br />BY PAID CLAIMS. <br />TYPEOFINSURANCE INSD <br />-SUBS POLICY NUMBER POLICY EVE MLICCYYEP <br />T82-641-005097-040 01/0112020 0ligV2021EACH <br />LIMITS <br />gCCURRENCE $ 2,000,000 <br />WMS-MADE OCCVR <br />PREMISES Eaacco e— tfMED <br />TXCOMMERCIALGENERALLIABILITY <br />EXP IAPERSONAL <br />S ADV INJURY $ 2,00%000 <br />EGATE LIMITAPPLIES PER: <br />JECOT LODPRODUCTS-COMPIOPAGG <br />GENERAL AGGREGATE If 4,000,000 <br />S 4,000,000 <br />$ <br />A AUTOMOBILE LIABILITY AI2-641-0050 7050 61101120 00 g110112021 <br />COMBINED INGLELIMIT <br />X ANY AUrO <br />JE. eccidnl $ 2,000.900 <br />SCHEDULED <br />BODILY INJURY (Per parson) $ <br />AUTOS <br />X X NOW OWNED <br />_ <br />BODILY INJURY(Pereccldsae $ <br />AUTOS ONLY <br />PReOaE�R ^DAMAGE S <br />J <br />OCCUR <br />EXCESSCLAIM9-MADE <br />EACH OCCURRENCE <br />$ <br />AGGREGATE <br />If <br />ENTION$ <br />— <br />C <br />WORKERS COMPENSATION <br />WA7-64D075097 .010 AOS <br />( ) <br />010112021 <br />X PER OTH- <br />$ <br />ANDEMPLOY Y!N <br />ANWROPRIETORIPARTNER/EXECUTIVE <br />"Includes°Step-Gap" <br />STATUTE ER <br />E.L. EACH ACCIDENT <br />S 1.000.000 <br />OFFICER/MEMBEREXCLUDEDa -] <br />NIA <br />IMendatory In NN) <br />E.L. DISEASE - EA EMPLOYEE <br />S 1.000,000 <br />If yes, describe under <br />1= <br />DESCRIPTION OF OPERATIONS below <br />— <br />E.L. DISEASE •POLICY LIMIT <br />§ 1,000,000 <br />DESCRIPTION OFOPERATIONSILOCATIONS/VEHICLES (ACORD101,Addlllomi Ramarae Schedule, may be attached If mom space larvqu(md) <br />Re: Citywide Traffic Signal Vehicle Head Upgrades (HSIPL-5062(iB8)) Project No. 17.6876. <br />CIIy of Santa Ana, Its officers, employees, agents and volunteers Were included as additional Insured under general liability per the attached CG 2010 and CG 2037 endorsements and doesn't Include <br />professional <br />Ilabllitycoverage, Blanket Additional Insured for Automobile Uabllltyis Included per attached designated Insured Endorsemem CA 2048. Primary and Non-Contdiumory apples fur General Llabllity per CG 2001 <br />attached. <br />n n r <br />CERTIFICATE <br />City of Santa Ana <br />Risk Management Division, 41h Floor <br />20 Civic Center Plaza <br />Santa Ana, CA 92701 <br />SHOULD ANY OF THE ABOVE DESCRIBED POLIOIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />AUTHORIZED REPRESENTATIVE <br />of Marsh USA Inc, <br />Manashi Mukher)ee ...M.nsnawar,L <br />U <br />riahts <br />--- 1--1—••-1 1 nc r wnw name one logo are registered marks of ACORD <br />