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AC4'PO' CERTIFICATE OF LIABILITY INSURANCE
<br />of/ 3/2020
<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(les) 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. r statement d.
<br />this cettiflcale does not confer rl hts to the certificate holder In lieu of such endorsements .
<br />PRODUC6R LIC #DE28842 1-949-756-. 100
<br />Tnvensure Insurance Brokers, Inc.
<br />17991 Cowan
<br />NAME:C Kathryn Lopez
<br />PHONE .949 956-4123 94g•756-4199
<br />AC No:
<br />Aoo L klo oa®lnvansure.com
<br />INSURERS AFFORDING COVERAGE
<br />NAICN
<br />Irvine, CA 92619
<br />INSVRERA: LIBERTY t4UT FIRR TNS CO
<br />23035
<br />INSURED
<br />RB8 General Enginearing, Ina,
<br />INSURERe: FIRST LIBERTY INS CORP
<br />33588
<br />INSURER C: LTH$RTY TN9 CORP
<br />42904
<br />INSURER O:
<br />1345 Quarry St.., Suite 101
<br />NSURER 6;
<br />Corona, CA 92879
<br />INSURERF:
<br />lvyz`nml. Q VCI4Nr1Cr4IrINOmt$t:K:>UJB11L1 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 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 />ILm
<br />TYPE OF INSURANCE
<br />R
<br />POLICY NVMaER
<br />Mptgg F
<br />POLOCY
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />X
<br />X
<br />TH2-Z91.454286-019AMM
<br />09/28/19
<br />09/28/20
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />CLAIMS -MADE 1�1OCCUR
<br />PREMISES E n ace
<br />E 100,000
<br />X
<br />MED EXP(An one arson)
<br />$ 5,000
<br />$2,500 Deductible
<br />PERSONAL B ADV INJURY
<br />$ 1,000,000
<br />AGGREGATE LIMIT APPLIES PER..
<br />O
<br />GENERAL AGGREGATE
<br />$ 2,000,000
<br />GEN'L
<br />PRODUCTS•COMPIOPAGG
<br />$ 2,000,000
<br />POLICY T je T 1-1 LOC
<br />�—
<br />$
<br />OTHER:
<br />B
<br />AUTOMOBILEUASIUTY
<br />X
<br />X
<br />AS6-Z91-454286-029
<br />09/28/19
<br />09/28/ 0
<br />COMBINED SINGLE I
<br />Ea am and
<br />E y,.000, 000
<br />X
<br />ANYAUTO
<br />BODILY INJURY (Per parson)
<br />E
<br />OWNEDSCHEDULED
<br />BODILY INJURY (Per accident
<br />$
<br />X
<br />HIRED X NON -OWNED
<br />AUTOSONLY AUTOS ONLY
<br />PROPERTY N ACC—
<br />War poon nl
<br />$
<br />$
<br />C
<br />X
<br />UMBRELLAUAB
<br />I X
<br />GCCUR
<br />TH7-Z91+454286-049
<br />09/28/29
<br />09/28/20
<br />EACHOCCURRENCE
<br />$ 4,000,000
<br />AGGREGATE_
<br />$ 4,000,000
<br />EXCESS LIAB
<br />CLAIMS•MADE
<br />DED I I RETENTION$
<br />$
<br />B
<br />WORKERS COMPENSATION
<br />AND EMPLOYERB'LIABILITY
<br />%
<br />WC6.291.454286-039
<br />09/28 /19
<br />09/28/20
<br />X OTH
<br />ST TUTS ER
<br />yy/N
<br />ANYPROPRIETOWPARTNERJEXECUTNE r"�1
<br />E.L. EACH ACCIDENT
<br />$ 1, 000, 000
<br />OFFICE"EMBEREXCLUUED7 Y
<br />(Mandatory In NH) it_JI
<br />NIA
<br />E.L. DISEASE• EA EMPLOYEE
<br />E 1,000,000
<br />8 yes, OescI'No andar
<br />E.L. DISEASE •POLICY LIMIT
<br />$ 1,000,000
<br />DESCRIPTION OF OPERAT ONS bet
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be altachad If more apace Is required)
<br />"Certificate holder is additional insured per forme CO2037 04 13 & CO2010 04 13, CA204S 10 13, GL Primary wording
<br />LC 24 20 11 18, Blanket GL waiver of aubrogation CG2404 05/09, Blanket FIC waiver of subrogation WC040306 4/84
<br />& Auto Waiver of Subrogation CA 04 44 1D 13 apply per attached. GL Per Project Agg applies par attached
<br />LC 25 19 01 25. Auto Primary applies per attached AC 84 23 08 11. 30 Days Notice of Cancellation Applies
<br />RXoept 10 Days Notice for Non. Payment of Premium. Project 1107st. 20-6956 & 20-6437
<br />Gas Tax Local Street Improvements PY 19/20 and Flower Street Sewer Manhole Improvements
<br />EBa820201
<br />13Y I1I5K IVIANAUU.MFNI..nn5SH)' I 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 />Risk Management70
<br />,.,, ,„ ,f �� ACCORDANCE WITH THE POLICY PROVISIONS.
<br />20 C1V1C Centel Plaza ,ill °I///-'"'17{`/111„lll,�',I/I� IAUTHORIZED REPRESENTATIVE
<br />Santa Ana,CA 92701 CnAaln[� + nr <e
<br />r-rYrrrTC"NX V8A � ,�..x6�C�-au..�f--
<br />ACO
<br />01988.2015 ACORD CORPORATION. All rights reserve)
<br />tball 25 (2018103) CORD name and logo are registered marks of ACORD
<br />ell
<br />58392121
<br />
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