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... 1 W IAC�R v CERTIFICATE OF LIABILITY INSURANCE DATE IMWDD1YYYYl 1 04/12/2021, THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVEOR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER K Taylor Inanrance Solution, LLC IBM Roseerans Ave., 4114 La Mirada CA 90630 CO TACT Ken Tay1or E; Y PHONE Alc. No sal• (562) 758 -3862 Vic, pp RIE k tpkta 10rinsuraRtle. tlam INSURERS) AFFORDING COVERAOE 14AICN INSURERA: Travelers Property Casualty Co 25674 INSURED (949) 400-1800 INSURERS; INSURER C: Big Ben, Inc. INSURER D: 4790 Irvine Blvd INSURERS: Irvin CA 92620 INSURER F ree,•,e:rn T. KII Inaeco. re.r Tn Al R REVISION NUMBER: COVERAGES THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE APFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE 13EFN REDUCED BY PAID CLAIMS. INart LTft •rypE OF INSURANCE A13-DL POUGY NUMBER MW.DrIYYICY EFFII PIUDCYYEX11 LIMITS COMMERCUILGENERALLIABILITY EACHOCCURRENCE a _ CLAIMS -MADE ❑ OCCUR PREMISES(Ea cecurrenne $ _ MED EXP Any one person) $ PERSONAL &ADV INJURY $ GEN'L AOGREGATE LIMITAPPLIES PER: GENERALAOOREGATE E PROOUCTS-COMP7JPA00 $ POLICY❑JPRa LOC OTHER'' AUTOMOBILE LIABILITYEe OCUB INEOS G LIMIT acaltlent $ 1, 000,p00 BODILY INJURY (Per person) $ A X ANY AUTO OWNED SCHEDULED AUTOSONLY AUTOS HIRED NON -OWNED X AUTOS ONLY X AUTOS ONLY y Y 510.1R20261A-20-26-0 07/01/2020 07/01/2021 BODILY INJURY IPereccMenl) $ RROPERTYDAMAGE Par acclde 1 $ $ UMSRELLALIAS OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAI"-MADE DED I I RETE NTION5 WORKERS COMPENSATION AND ROPRIE ORiPARTNE Y YIN OFFICE IMEMS IREXCL ERIEXECUTIVE ❑ OFFICERfMEMSEREXCLU0E07 (M,ttle er In NH) If es describe under D SCRIPTIONO OPERATIONS b9IW STA7U1'E OERH E.L. EA0HACCIDENT $ $ 11000,000 A NIA y UB-IR22559A-20-26.0 07/01/2020 07/01/2022 EA E.L. DISEASE -EA EMPLOYEES 1r P00,000 E.L. DISEASE -POLICY LIMIT 8 1,D00,00a a S DESCRIPTION OF OPERATIONS I LOCATIONS VEHICLES IACORD101, AddI0011al Remarks Schedule, may11eeffeohad8moroapaee II City of Banta Ana, officers, agents, employees, and volunteers are named as additional insured whop required by written contract per form CA T3 $3 02 15. A waiver of subrogation applies as required by written contract per form CA T3 53 02 15 & WC 99 03 76 ( A). 30 day NOC applieB per form WC 99 06 R3 (00) and IL T4 05 05 19. Primary and Non -Contributory wording applies per form CA T4 99 02 16. Policies shall not be Cancelled or reduced in coverage or obanged in any other material aspect, by contractor, without thirty (30) days prior written notice to the City. Project No. 21-6446 Baker OlanWOod Sewer Main Upgrade City of Santa Ana Risk Management Division 20 Civic Center Plaza 4th floor Santa Ana, CA 92701 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. A 4966-2016 ACORD COI ACORD 26 (2016/03) The ACORD name and logo are registered marks of ACORD Page 1 of 1 Rtek Managxrnwtt DMslmt yREVIEWED&APP�eRe4VEDRY: 8 LL.P t•4AUwpw P. V 1� Risk Management Anal1YA