|
Francine Digitally signed by
<br />Francine R. Villareal
<br />R. Villareal 111:2020.11.114:2827-08'008
<br />CERTIFICATE OF LIABILITY INSURANCE
<br />OATE(MN0827/2020 VV)
<br />/2020
<br />1
<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 pollcy(tas) 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 10 the certificate holder in lieu of such endorsemeni(s).
<br />PRODUCER
<br />AOn Risk Services Central, Inc.
<br />Pittsburgh PA Office
<br />EQT Plaza - Suite 2700
<br />625 Liberty Avenue
<br />CONTACT
<br />NAME:
<br />(Are. No. EzU: (866)ONE 283-7122 FAX Nn : (800) 363-0105
<br />E-MAIL
<br />ADDRESS:
<br />Pittsburgh PA 15222-3110 USA
<br />INSURER(S) AFFORDING COVERAGE
<br />NAIL It
<br />INSURED
<br />INSURERA: 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 />INSURER E: Allied World Surplus Lines Insurance Co
<br />24319
<br />INSURER F:
<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 />LTq
<br />TYPE OF INSURANCE
<br />INSD
<br />BUSH
<br />MD
<br />POLICY NUMBER
<br />MMIDOIYV
<br />POLICYEXP
<br />MAVDOIYVVY
<br />LIMITS
<br />a
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />CLAIMB-MAOF X OC
<br />- ❑ OUR
<br />7
<br />General Liability
<br />6079257181
<br />08/30/2020
<br />08/30/2021
<br />EACH OCCURRENCE
<br />$2,000,000
<br />O
<br />PREMISES Ea occurrence
<br />$100, 000
<br />MED EXP(Anyone person)
<br />$10,000
<br />20-21 Stop Gap (US)
<br />PERSONAL&ADV INJURY
<br />$2,000,000
<br />GEN'LAGGREGATE LIMITAPPLIES PER:
<br />GENERALAGGREGATE
<br />$4,000,000
<br />POLICY X PRO- X LOG
<br />JECT
<br />PRODUCTS - COMPIOPAGG
<br />$4,000,0OD
<br />OTHER:
<br />C
<br />AUTOMOBILE LIABILITY
<br />BUA 6078988690
<br />08/30/2020
<br />08/30/2021
<br />COMBINED SINGLE LIMIT
<br />accident)
<br />$2, 000, 000
<br />BODILY INJURY) Per person)
<br />X ANYAUTO
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />HIREOAUTOS NON OWNED
<br />ONLY AUTOS ONLY
<br />BODILY INJURY (Per acrddenq
<br />PROPERTY DAMAGE
<br />Per acddenl
<br />D
<br />X
<br />UMBgELLALIAB
<br />X
<br />OCCUR
<br />03124809
<br />09/30/2020
<br />08/30/2021
<br />EACH OCCURRENCE
<br />$10,000,000
<br />EXCESSLIAS
<br />CLAIMS MADE
<br />AGGREGATE
<br />$10,000,000
<br />CEO I X
<br />RETENTION SIG, 000
<br />A
<br />B
<br />WORKERS COMPENSATIONAND
<br />EMPLOYERS' LIABILITY YIN
<br />ANY PROPRIETOR I PARTNER I EXECUTIVE
<br />OFFICEHIMEMBER EXCLUDEOP
<br />NIA
<br />WC6078988713
<br />ADS
<br />wC6O]B9$$]2]
<br />08/30/2020
<br />OB/30/2020
<br />08/30/2021
<br />OB/30/2021
<br />X I PER STATUTE OTH
<br />HER
<br />E.L. EACH ACCIDENT
<br />81, 000, 000
<br />71 DISEASE -EA EMPLOYEE
<br />$1,000,000
<br />(Mandatory in NH)
<br />If yes, desctlbe under
<br />DESCRIPTION OF OPERATIONS below
<br />WI
<br />E.L. OISEASE-POLICY LIMIT
<br />$1,000,000
<br />E
<br />E&O-PL-Primary
<br />03124806
<br />DS/30/2020
<br />08/30/2021
<br />Per Clairn
<br />$5,000,000
<br />Claims Made
<br />Aggregate
<br />$5,000,000
<br />SIR applies per policy terms
<br />& condi
<br />ions
<br />DESCRIPTION OF OPERATIONS I LOCATIONS/ VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required)
<br />For Named Insured Only: Attn: Kim Hartsfield. RE: Project Name: CEQA/NEPA On -call Environmental services. City of Santa
<br />Ana, its officers, agents, employees, volunteers and representatives are included as Additional Insured in accordance with the
<br />policy provisions of the General Liability policy. General Liability policy evidenced herein is Primary and Non-contributory
<br />to other insurance available to Additional Insured, but only in accordance with the pof icy's provisions. should General
<br />Liability, Automobile Liability, Professional Liability and Workers' Compensation policies be cancelled before the expiration
<br />date thereof, the policy provisions will govern how notice of cancellation may be delivered to Certificate Holders in
<br />accordance with the policy provisions.
<br />od
<br />m
<br />ro
<br />co
<br />m
<br />Co
<br />n
<br />N
<br />CERTIFICATE HOLDER CANCELLATION i2i
<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 And
<br />AUTHORIZED REPRESENTATIVE
<br />a�-7
<br />Risk Management Division
<br />20 Civic Center Plaza, 4th
<br />Santa Ana CA 92702 USA
<br />floor
<br />aF
<br />a_j�j//osy ,�-q7
<br />y�elsy
<br />:
<br />WkkMn,AgelnodDtwimT
<br />REVIEMIED Er APPRov®8Y:
<br />ACORD 25 (2016/03)
<br />01988.2015 ACORD CO
<br />The ACORD name and logo are registered marks of ACORD
<br />F4Arr.:a.e �• � '��
<br />- Rhk Management Andyst
<br />
|