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<br />Dill[41,1gnedby Frantlne R.
<br />Francine R. Villareal M11:0
<br />AI o CERTIFICATE OF LIABILITY INSURANCE
<br />DATEIMMIDDIYYYY)
<br />6/24/2021
<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.
<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 endorsements).
<br />PRODUCER
<br />AssuredPartners Design Professionals Insurance Services, LLC
<br />3697 Mt. Diablo Blvd., Suite 230
<br />Lafayette CA 94549
<br />Ferri k
<br />NAME: CT Nancy FerrlCk
<br />CONTPHONE
<br />• 5c Fax
<br />A/C NO
<br />E-MAIL
<br />ADDRESS• nanc .ferI assured artners.com
<br />INSURERS AFFORDING COVERAGE
<br />NAIC#
<br />INSURER A: Travelers Casualty and Surety Cc of America
<br />31194
<br />Li------: 6003745
<br />INSURED BUTIEENGI
<br />Butler Engineering, Inc.
<br />Tustin Financial Center
<br />INSURER B: The Travelers Indemnity Company of Connecticut
<br />25682
<br />INSURERC: Travelers Property Casualty Company of America
<br />25674
<br />NSURER:;
<br />17822 E 17th St., Suite 404
<br />Tustin CA 92780
<br />INSURER E
<br />NSURERF;
<br />LVVt:jrua 3 GEHIIHUAIE NrIMRFR•9RRR96R49 ocancansr sinnm vn.
<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 />SUER
<br />i POLICYNUMBER
<br />MMIDDYY
<br />MM/DO/9YYV
<br />LIMITS
<br />B
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />CLAIMS-MADE"OCCUR
<br />Y
<br />Y
<br />6801RI26463
<br />6/25/2021
<br />6/25/2022
<br />EACHOCCURRENCE
<br />$1,000,000
<br />D ERENTED
<br />PREMIMISESS(Ea occurrence)
<br />$1,000,000
<br />MED EXP(Any one person)
<br />$10,000
<br />PERSONAL &ADV INJURY
<br />$1,000,000
<br />AGGREGATE LIMIT APPLIES PER:
<br />POLICY[fljEo- �LOC
<br />GENERAL AGGREGATE
<br />$2,000,000
<br />GENT
<br />PRODUCTS - COMP/OP AGG
<br />$2,000,000
<br />$
<br />OTHER,
<br />B
<br />AUTOMOBILE
<br />X
<br />LIABILITY
<br />ANY AUTO
<br />Y
<br />Y
<br />BABR660917
<br />6/25/2021
<br />6/25/2022
<br />COMBINED SINGLE LIMIT
<br />Ea accident
<br />$1'000,000
<br />BODILY INJURY (Per person)
<br />$
<br />X
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />AUTOS ONLYHIRED X Nol AUTOS ONLY
<br />BODILY INJURY (Per eccidenl)
<br />$
<br />PROPERTY DAMAGE
<br />Par accident
<br />$
<br />UMBRELLA LIAB
<br />OCCUR
<br />EACH OCCURRENCE
<br />$
<br />AGGREGATE
<br />$
<br />EXCESS ICLAIMS-MADE
<br />DED I I RETENTION$
<br />$
<br />C
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY YIN
<br />ANYPROPRIETOR/PARTNER/EXECUTIVE
<br />OFFICER)MEMBEREXCLUDE09 N
<br />NIA
<br />Y
<br />UB9R659873
<br />7/1/2021
<br />7/l/2022
<br />X I STATUTE EORN
<br />E.L. EACH ACCIDENT
<br />$1,000,000
<br />E.L. DISEASE - EA EMPLOYEE
<br />$1,000,000
<br />(Mandatory In NH)
<br />If yes, deaAba under
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE -POLICY LIMIT
<br />$1,000,000
<br />A
<br />Professional Liability
<br />107108511
<br />6/25/2021
<br />6/25/2022
<br />$1,000,000
<br />$2,000000
<br />per Claim
<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 />F,FR iyi l t HULUEK CANCELLATION 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 />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 />�yc � RlekMangletnentDii,iaicn
<br />REMEWED&APPROVEDBY:
<br />I�' NukManagemetil Andl�sS.
<br />
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