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Francine R. <br />Digitally signed by <br />Francine R. Villareal <br />Villareal <br />Date:2021.07.06 <br />09:41:15-07'00' <br />� ® <br />�`� o CERTIFICATE OF LIABILITY INSURANCE <br />DATE(MM/DD/YYYY) <br />D6/,B/2D2, <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 southwest, Inc. <br />Houston TX Office <br />CONTACT <br />NAME: <br />(A/C.o. Ext): (866) 283-7122 A/C No : (800) 363-0105 <br />E-MAIL <br />ADDRESS: <br />5555 San Felipe <br />suite 1500 <br />INSURER(S) AFFORDING COVERAGE <br />NAIC # <br />Houston TX 77056 USA <br />INSURED <br />INSURER A: AIG Specialty Insurance Company <br />26883 <br />JWGUSA Holdings, Inc. <br />and its subsidiaries and Affiliates <br />17325 Katy Freeway <br />INSURERB: American International Group UK Ltd <br />AA1120187 <br />INSURER C: Zurich American Ins Co <br />16535 <br />Houston TX 77084 USA <br />INSURER D: ACE American Insurance Company <br />22667 <br />INSURERE: ACE Fire Underwriters Insurance Co. <br />20702 <br />INSURER F. <br />COVERAGES CERTIFICATE NUMBER: 570087917805 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 />GLO <br />EACH OCCURRENCE <br />$5,000,000 <br />CLAIMS -MADE X❑ OCCUR <br />PREMISES Ea occurrence)$100, <br />000 <br />MED EXP (Any one person) <br />$ 5 , 000 <br />PERSONAL& ADV INJURY <br />$5,000,000 <br />GEN'LAGGREGATE LIMIT APPLIES PER: <br />GENERAL AGGREGATE <br />$5,000,000 <br />POLICY x PRO ❑ LOC <br />JECT <br />PRODUCTS - COMP/OPAGG <br />$5,000,000 <br />OTHER: <br />D <br />AUTOMOBILE LIABILITY <br />ISA H2555047A <br />07101120210710112022 <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 />UMBRELLALIAB <br />OCCUR <br />EACH OCCURRENCE <br />AGGREGATE <br />EXCESS LIAB <br />CLAIMS -MADE <br />DED I RETENTION <br />D <br />WORKERS COMPENSATION AND <br />WLRC67807674 <br />07101120210710112022 <br />X I PER STATUTE I OTH- <br />ER <br />EMPLOYERS' LIABILITY v/N <br />Work Comp- ADS <br />E.L. EACH ACCIDENT <br />$1, 000 , 000 <br />E <br />ANY PROPRIETOR / PARTNER /EXECUTIVE <br />5CFC67807716 <br />07�01�2021 <br />07�01�2022 <br />OFFICER/MEMBER EXCLUDED? <br />(Mandatory in NH) <br />N/A <br />Work Comp- WI <br />E.L. DISEASE -EA EMPLOYEE <br />$1, 000, 000 <br />If yes, describe under <br />DESCRIPTION OF OPERATIONS below <br />I <br />I <br />I <br />E.L. DISEASE -POLICY LIMIT <br />$1, 000, 000 <br />B <br />Archit&Eng Prof <br />PSDEF2100726 <br />07/01/20211071011202 <br />2 <br />Aggreagate Limit <br />$5,000,000 <br />Claims Made- Prof. Liab. <br />Any One Claim <br />$5,000,000 <br />SIR applies per policy terns <br />& condiions <br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) <br />SEE ATTACHED ADDENDUM FOR ADDITIONAL NAMED INSURED AMEC COMPANIES. RE: NPDES Inspection and Database Management and As -Needed <br />Services City of Santa Ana, its officers, employees, agents and representatives are Additional Insured on the General Liability <br />policy as required by written contract. General Liability policy is Primary and Non -Contributory where required by written <br />contract. <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 />a� <br />rn <br />0 <br />n <br />rn <br />00 <br />0 <br />0 <br />r- <br />O <br />Z <br />O <br />R <br />V <br />U <br />City of Santa Ana AUTHORIZED REPRESENTATIVE <br />Risk Management Division <br />20 Civic Center Plaza '� <br />Santa Ana CA 92702 USA c (�s¢�/ a !iJ//uofG._ `/ <br />a�„ortaNc RAMwagementDMsian <br />@1988-2015ACORIDCOR REVIEWED & APPROVED BY. <br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD <br />Risk Management Analyst <br />