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Francine R.
<br />Villareal
<br />Digitally signed by Francine R.
<br />Villareal
<br />Date: 2021.05.26 13:15:21
<br />-07'00'
<br />� ®
<br />�`� o CERTIFICATE OF LIABILITY INSURANCE
<br />DATE(MM/DD/YYYY)
<br />DB/27/2D2D
<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. If
<br />SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this
<br />certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
<br />PRODUCER
<br />AOn Risk Services Central, Inc.
<br />Pittsburgh PA Office
<br />CONTACT
<br />NAME:
<br />PHONE
<br />(A/CNo.Ext): (866) 283-7122 A/C No.): (800) 363-0105
<br />E-MAIL
<br />ADDRESS:
<br />EQT Plaza — Suite 2700
<br />625 Liberty Avenue
<br />INSURER(S) AFFORDING COVERAGE
<br />NAIC #
<br />Pittsburgh PA 15222-3110 USA
<br />INSURED
<br />INSURER A: American Casualty CO. Of Reading PA
<br />20427
<br />Michael Baker International, Inc
<br />5 Hutton Centre Drive
<br />suite 500
<br />INSURER B: Transportation Insurance Co.
<br />20494
<br />INSURER C: Continental Casualty Company
<br />20443
<br />Santa Ana CA 92707 USA
<br />INSURER D: Allied World National Assurance Company
<br />10690
<br />INSURERE: Allied World Surplus Lines Insurance Co
<br />24319
<br />INSURER F.
<br />COVERAGES CERTIFICATE NUMBER: 570083686677 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. Limits shown are as requested
<br />LTR
<br />TYPE OF INSURANCE
<br />I N S DI
<br />WVD
<br />I POLICY NUMBER
<br />MM/DD/YYYY
<br />MM/DD/YYYY
<br />LIMITS
<br />C
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />_67777EACH
<br />77
<br />OCCURRENCE
<br />$2 , 000, 000
<br />CLAIMS -MADE X OCCUR
<br />General Liability
<br />$100,000
<br />B
<br />6079257181
<br />08/30/2020
<br />08/30/2021
<br />PREMISES Ea occurrence
<br />MED EXP (Any one person)
<br />$10, 000
<br />20-21 Stop Gap (US)
<br />PERSONAL& ADV INJURY
<br />$2,000,000
<br />GEN'LAGGREGATE LIMIT APPLIES PER:
<br />GENERAL AGGREGATE
<br />$4,000,000
<br />POLICY x PRO El LOC
<br />JECT
<br />PRODUCTS - COMP/OP AGG
<br />$4,000,000
<br />OTHER:
<br />C
<br />AUTOMOBILE LIABILITY
<br />BUA 6078988680
<br />08/30/2020
<br />08/30/2021
<br />COMBINED SINGLE LIMIT
<br />Ea accident
<br />$2 , 000, 000
<br />BODILY INJURY ( Per person)
<br />X ANY AUTO
<br />BODILY INJURY (Per accident)
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />HI RED AUTOS NON -OWNED
<br />PROPERTY DAMAGE
<br />ONLY AUTOS ONLY
<br />Per accident
<br />D
<br />X
<br />UMBRELLALIAB
<br />X
<br />OCCUR
<br />03124809
<br />08/30/2020
<br />08/30/2021
<br />EACH OCCURRENCE
<br />$10,000,000
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />AGGREGATE
<br />$10, 000, 000
<br />DED I X RETENTION $10, 000
<br />A
<br />WORKERS COMPENSATION AND
<br />wc6078988713
<br />08/30/2020
<br />08/30/2021
<br />X PER STATUTE OTH-
<br />ER
<br />EMPLOYERS' LIABILITY Y/ N
<br />ADS
<br />E.L. EACH ACCIDENT
<br />$1, 000 , 000
<br />B
<br />ANY PROPRIETOR / PARTNER / EXECUTIVE
<br />WC6078988727
<br />08/30/2020
<br />08/30/2021
<br />OFFICER/MEMBER EXCLUDED? F9
<br />(Mandatory in NH)
<br />N/A
<br />wi
<br />E.L. DISEASE -EA EMPLOYEE
<br />$1, 000, 000
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE -POLICY LIMIT
<br />$1, 000, 000
<br />E
<br />E&O-PL-Primary
<br />03124806
<br />08/30/2020
<br />08/30/2021
<br />Per Claim
<br />$5,000,000
<br />Claims Made
<br />Aggregate
<br />$5,000,000
<br />SIR applies per policy terns
<br />& condi
<br />ions
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
<br />RE: Civic Center Stormwater Lift Station Renovation. MB Project No. 167946. Agreement No. A-2016-093 / A-2015-170 / A-2018-177.
<br />City of Santa Ana, Ross Anex is included as Additional Insured in accordance with the policy provisions of the General
<br />Liability policy.
<br />General Liability evidenced herein is Primary/Non-Contributory to other insurance available to an Additional Insured, but only
<br />in accordance with the policy's provisions.
<br />Should any of the above described policies be cancelled before the expiration date thereof, the policy provisions will govern
<br />how notice of cancellation may be delivered to certificate holders in accordance with the policy provisions of each policy.
<br />CERTIFICATE HOLDER CANCELLATION
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
<br />EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE
<br />POLICY PROVISIONS.
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<br />City Of Santa Ana, Ross Anex AUTHORIZED REPRESENTATIVE
<br />City of Santa Ana, Ross Anex
<br />20 Civic Center Plaza
<br />Santa Ana CA 92702 USA
<br />a�„ortaNc RAMatlagemerdDMsian
<br />©1988-2015 ACORD CO r REVIEWED &APPROVED BY.-
<br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD TCU4.C+�
<br />Risk Management Analyst
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