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Digitally signed by Tori Pierson
<br />To r i Pierson Date: 2022.04.20 08:33:46
<br />-07'00'
<br />ACCORD® CERTIFICATE OF LIABILITY INSURANCE
<br />DATE(MM/DD/YYYY)
<br />9/13/2021
<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
<br />Marsh & McLennan Agency, LLC
<br />8144 Walnut Hill Lane, 16th FI
<br />TX 75231
<br />CONTACT
<br />NAME: Stacy Brlmer
<br />PHONE FAX
<br />A/c No Ext : A/C, No): 972-376-8108
<br />E-MDallas
<br />ADDRESS: stacy.brimer@marshmma.com
<br />INSURER(S) AFFORDING COVERAGE
<br />NAIC #
<br />INSURERA: Hartford Casualty Insurance Company
<br />29424
<br />INSURED HUITTZOL
<br />INSURERB: Federal Insurance Company
<br />20281
<br />Huitt-Zollars, Inc.
<br />5430 LBJ Freeway, Suite 1500
<br />INsuRERc: Hartford Underwriters Insurance Company
<br />30104
<br />INSURERD:
<br />Dallas TX 75240
<br />INSURER E
<br />INSURER F :
<br />COVERAGES CERTIFICATE NUMBER:2037544229 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 />INSR
<br />LTR
<br />TYPE OF INSURANCE
<br />ADDL
<br />INSD
<br />SUBR
<br />WVD
<br />POLICYNUMBER
<br />POLICY EFF
<br />MM/DD
<br />POLICY EXP
<br />MM/DD
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />46UUNOL5275
<br />9/1/2021
<br />9/1/2022
<br />EACH OCCURRENCE
<br />$1,000,000
<br />CLAIMS -MADE OCCUR
<br />DAMAGE TO RENTED
<br />PREMISES Ea occurrence
<br />$ 300,000
<br />X
<br />MED EXP (Any one person)
<br />$ 10,000
<br />Deductible: $0
<br />PERSONAL &ADV INJURY
<br />$ 1,000,000
<br />GEN'L
<br />AGGREGATE LIMIT APPLIES PER:
<br />GENERAL AGGREGATE
<br />$ 2,000,000
<br />POLICY � ECT � LOC
<br />PRODUCTS - COMP/OP AGG
<br />$ 2,000,000
<br />$
<br />OTHER:
<br />A
<br />AUTOMOBILE
<br />LIABILITY
<br />46UENOL5276
<br />9/1/2021
<br />9/1/2022
<br />COMBINED SINGLE LIMIT
<br />Ea accident
<br />$1,000,000
<br />X
<br />BODILY INJURY (Per person)
<br />$
<br />ANY AUTO
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />BODILY INJURY (Per accident)
<br />$
<br />PROPERTY DAMAGE
<br />Per accident
<br />$
<br />HIRED NON -OWNED
<br />AUTOS ONLY AUTOS ONLY
<br />X
<br />$
<br />Coll $1,000 X Comp $1,000
<br />A
<br />X
<br />UMBRELLALIAB
<br />X
<br />OCCUR
<br />46XHUOL5274
<br />9/1/2021
<br />9/1/2022
<br />EACH OCCURRENCE
<br />$ 10,000,000
<br />AGGREGATE
<br />$ 10,000,000
<br />EXCESS LAB
<br />CLAIMS -MADE
<br />DED X RETENTION $ 1 n nnn
<br />$
<br />C
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY Y / N
<br />ANYPROPRIETOR/PARTNER/EXECUTIVE
<br />46WEOL6H1G
<br />9/1/2021
<br />9/1/2022
<br />X PER OTH-
<br />STATUTE ER
<br />E.L. EACH ACCIDENT
<br />$ 1,000,000
<br />OFFICER/MEMBER EXCLUDED? FN]
<br />N/A
<br />E.L. DISEASE - EA EMPLOYEE
<br />$ 1,000,000
<br />(Mandatory in NH)
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE - POLICY LIMIT
<br />$ 1,000,000
<br />A
<br />Hired Car Physical Dam: $100,000
<br />46UENOL5276
<br />9/1/2021
<br />9/1/2022
<br />Hired PD Comp/Coll
<br />Ded $1,000/$1,000
<br />B
<br />A
<br />Employee Theft
<br />Valuable Papers
<br />82241508
<br />46UUNOL5275
<br />9/1/2021
<br />9/1/2021
<br />9/1/2022
<br />9/1/2022
<br />Employee Theft
<br />Included in BPP Limit
<br />Limit: $1,000,000
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required)
<br />Additional Insured form #HG0001 edition 09/16 applies to the General Liability policy.
<br />Waiver of subrogation form #HG0001 edition 09/16 applies to the General Liability policy.
<br />Primary & Non -Contributory General Liability form #HG0001 edition 09/16.
<br />Additional Insured form #HA9916 edition 03/12 applies to the Automobile Liability policy.
<br />Waiver of subrogation form #HA9916 edition 03/12 applies to the Automobile Liability policy.
<br />Primary & Non -Contributory Auto Liability form #HA9916 edition 03/12.
<br />See Attached...
<br />CERTIFICATE HOLDER CANCELLATION
<br />City of Santa Ana Public Works Agency,
<br />its officers, employees, agents,
<br />Volunteers and Representatives
<br />20 Civic Center Plaza
<br />Santa Ana CA 97201
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />AUTHORIZED �
<br />REPRESENTATIVE , t p„c
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<br />@ 1988-2015 ACORD C(
<br />ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD
<br />
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