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DigRally signed by Francine
<br />Francine R. Villareal "IIveal
<br />Ak CERTIFICATE OF LIABILITY INSURANCE
<br />UATE/YYYY)
<br />s/24/20a/zo21
<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(tes) must have ADDITIONAL INSURED provisions or be endorsed.
<br />If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on
<br />this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
<br />PRODUCER
<br />AssuredPartners Design Professionals Insurance Services, LLC
<br />3697 Mt. Diablo Blvd., Suite 230
<br />Lafayette CA 94549
<br />y
<br />CONTACT
<br />Nancy Ferrick
<br />PHONE
<br />510-272-1400 FAX No:
<br />E-MAIL
<br />ADDRESS: nanC .ferrick assured artners.com
<br />INSURERS AFFORDING COVERAGE
<br />NAICd
<br />INSURER A: Travelers Casualty and Surety Cc of America
<br />31194
<br />License#: 6003745
<br />INSURED BUTIEENGI
<br />Butier Engineering, Inc.
<br />Tustin Financial Center
<br />INSURER B: The Travelers Indemnity Company of Connecticut
<br />25682
<br />INSURER C; Travelers Property Casualty Company of America
<br />25674
<br />17822 E 17th St., Suite 404
<br />Tustin CA 92780
<br />INSURER D:
<br />INSURER E :
<br />INSURER F
<br />COVERAGES CERTIFICATE NUMRFR•9RRNRRRAR oc.ncrnu unamvn.
<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.
<br />INSR
<br />LTR
<br />TYPE OF INSURANCE
<br />ADDL
<br />ii
<br />SUBR
<br />Wan
<br />POLICYNUMBER
<br />POLICYYYY
<br />(yrienimin6/25/2021
<br />MM%ODY
<br />LIMITS
<br />B
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />V
<br />Y
<br />6801R125463
<br />6/25/2022
<br />EACH OCCURRENCE
<br />$1,000,000
<br />FRVI CLA
<br />CLAIMS -MADE OCCUR
<br />ERENTED
<br />PREMI
<br />PREMISESSI Ee ouurrence
<br />$1,000,000
<br />MED EXP (Any one person)
<br />$10,000
<br />PERSONAL& AW INJURY
<br />$1.000,000
<br />AGGREGATE LIMIT APPLIES PER:
<br />GENERALAGGREGATE
<br />$2,000,000
<br />GEN'L
<br />POLICY jEo- LOC
<br />PRODUCTS - COMP/OPAGG
<br />$2,000,000
<br />$
<br />OTHER:
<br />B
<br />AUTOMOBILELIABILITY
<br />V
<br />Y
<br />BABR660917
<br />6/25/2021
<br />6/25/2022
<br />COMBINED SINGLE LIMIT Ea accident
<br />g1,000,000
<br />ANY AUTO
<br />X
<br />BODILY INJURY (Per person)
<br />$
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />BODILY INJURY (Per accident)
<br />$
<br />X
<br />HIRED X NON -OWNED
<br />AUTOS ONLY AUTOS ONLY
<br />PROPERTY DAMAGE
<br />$
<br />Per acdtlent
<br />UMBRELLA LIAB
<br />OCCUR
<br />EACH OCCURRENCE
<br />$
<br />AGGREGATE
<br />$
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />DEO I i RETENTION$
<br />$
<br />C
<br />WORKERS COMPENSATION
<br />V
<br />UB9R659873
<br />7/1/2021
<br />7/1/2022
<br />X PER
<br />ERH
<br />AND EMPLOYERS' LIABILITY YIN
<br />E.L. EACH ACCIDENT
<br />$1,000,000
<br />ANVPROPRIETORIPARTNER/EXECUTIVE N
<br />OFRCERIMEMBEREXCLUOED]
<br />NIA
<br />E.L. DISEASE -EA EMPLOYEE
<br />$1,000,000
<br />(Mandatory In NH)
<br />If yes, describe under
<br />E.L. DISEASE -POLICY LIMIT
<br />$1,000,000
<br />DESCRIPTION OF OPERATIONS below
<br />A
<br />Professional Liability
<br />107108511
<br />6/25/2021
<br />6/25/2022
<br />$1,000,000
<br />per Claim
<br />$2,GW,000
<br />Annual Aggregate
<br />DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required)
<br />RE: SOUTH MAIN CORRIDOR IMPROVEMENTS PROJECT / RFP # 20-115. The City of Santa Ana, its officers, employees, agents, volunteers and
<br />representatives are named as Additional Insured for General and Auto Liability as required by written contract or agreement. General Liability Insurance is
<br />primary and non-contributory per policy form. A Waiver of Subrogation applies per the attached endorsement(s). 30 Days Notice of Cancellation.
<br />City of Santa Ana
<br />Risk Management Division, 4th Floor
<br />20 Civic Center Plaza (M-21)
<br />P.O. Box 1988
<br />Santa Ana, CA 92702
<br />Of
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />©1988-2015 ACORD C
<br />ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD
<br />.v. s•,.<f a RiskManWrialtDivislon
<br />R'�EVIEWED&IIJA�PPROVVED BY::
<br />'las,.aiaa:.u-� rA/ nfiNe2 Tom, vjj_"�
<br />Ruk Management Analyst
<br />
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