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Francine R.
<br />Villareal
<br />Digitally signed by Francine R.
<br />Villareal
<br />Date: 2021.03.23 10:52:03-0700'
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<br />�`k o CERTIFICATE OF LIABILITY INSURANCE
<br />DATE(MM/DD/YYYY)
<br />03/19/2021
<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. 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 Insurance services West, Inc.
<br />Los Angeles CA Office
<br />CONTACT
<br />NAME:
<br />(A/CN o. Ext): C866) 283-7122 FAX
<br />No : (800) 363-0105
<br />E-MAIL
<br />ADDRESS:
<br />707 Wilshire Boulevard
<br />suite 2600
<br />INSURER(S) AFFORDING COVERAGE
<br />NAIC #
<br />LOS Angeles CA 90017-0460 USA
<br />INSURED
<br />INSURER A: Travelers Property Cas CO Of America
<br />25674
<br />Willdan Engineering
<br />2401 East Katella Avenue
<br />INSURERB; Lexington Insurance Company
<br />19437
<br />INSURER C:
<br />suite 300
<br />Anaheim CA 92806 USA
<br />INSURER D:
<br />INSURER E:
<br />INSURER F:
<br />COVEHAGES CERTIFICATE NUMBER: b1UU8b4b888b 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 />INSD
<br />WVD
<br />I POLICY NUMBER
<br />MM/DD/YYYY
<br />MI'Vil YYYY
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />3 T1L67=
<br />EACH OCCURRENCE
<br />$1,000,000
<br />CLAIMS -MADE x1OCCUR
<br />PREMISES Ea occurrence)$1,000,000
<br />X
<br />MED EXP (Any one person)
<br />$15 , 000
<br />Employee Benefits Liability
<br />X
<br />Contractual Liability Included
<br />PERSONAL& ADV INJURY
<br />$1,000,000
<br />GEMLAGGREGATE LIMITAPPLIES PER:
<br />GENERAL AGGREGATE
<br />$2,000,000
<br />X POLICY ❑ PRO ❑ LOC
<br />JECT
<br />PRODUCTS - COMP/OP AGG
<br />$2,000,000
<br />OTHER:
<br />A
<br />AUTOMOBILE LIABILITY
<br />810-7N676545-20-43-G
<br />11/09/2020
<br />11/09/2021
<br />COMBINED SINGLE LIMIT
<br />(Ea accident)
<br />$1,000,000
<br />BODILY INJURY ( Per person)
<br />X ANYAUTO
<br />BODILY INJURY (Per accident)
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />HIRED AUTOS NON -OWNED
<br />PROPERTY DAMAGE
<br />ONLY AUTOS ONLY
<br />Per accident
<br />UMBRELLA LIAB
<br />EACH OCCURRENCE
<br />AGGREGATE
<br />EXCESS LIAB
<br />HOCCUR
<br />CLAIMS -MADE
<br />DED RETENTION
<br />A
<br />WORKERS COMPENSATION AND
<br />UBOL6636782043G
<br />11/09/2020
<br />11/09/2021
<br />X PER STATUTE OTH-
<br />EREMPLOYERS'
<br />LIABILITY Y/ N
<br />E.L. EACH ACCIDENT
<br />$1,000,000
<br />ANY PROPRIETOR / PARTNER / EXECUTIVE
<br />N
<br />OFFICER/MEMBER EXCLUDED?
<br />(Mandatory in Ni
<br />N / A
<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 />B
<br />Archit&Eng Prof
<br />028174512
<br />11/09/2020
<br />11/09/2021
<br />Aggregate
<br />$2,000,000
<br />SIR applies per policy terns
<br />& condi
<br />ions
<br />Per Claim
<br />$1,000,000
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
<br />RE: TO provide engineering services on an as -needed basis. Engineering services may include, but are not limited to, civil
<br />engineering, electrical engineering, traffic engineering, geotechnical, land/property surveying, structural, architecture and
<br />landscaping design services and grant writing services. General Liability policy excludes claims arising out of the performance
<br />of professional services. Independent Contractors are included as respects to General Liability.
<br />City of Santa Ana, officers, agents, employees, and volunteers are included as Additional Insureds in accordance with the
<br />policy provisions of the General Liability= and Automobile Liability policies. General Liability, and Automobile Liability
<br />evidenced herein are Primary and Non -Contributory to other insurance available to an Additional Insured, but only in accordance
<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.
<br />City Of Santa Ana AUTHORIZED REPRESENTATIVE
<br />Risk Management Division
<br />20 Civic Center Plaza, 4th floor �J �(�Kl�{ /T
<br />Santa Ana CA 92702 USA e'an . K1 SFn41WMM
<br />©1988-2015 ACORD
<br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
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<br />Risk MwagMl'12nt DiMisiun
<br />REVIEWED & APPROVED BY:
<br />r
<br />E ~ Risk Management Analyst
<br />
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