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<br />Tori Pierson o kX't" sc sxa3s
<br />, as CERTIFICATE OF LIABILITY INSURANCE
<br />ACO/ZO
<br />DATE(MNvODmm)
<br />DalaarzozT
<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 />Ann Risk services Central, Inc.
<br />Pittsburgh PA office
<br />CONTACT
<br />NAME:
<br />PHONE
<br />INC
<br />FAX
<br />No. Fall: (866) 283-7122 A/C. No.: (800) 363-0105
<br />EQT Plaza - suite 2700
<br />625 Liberty Avenue
<br />EMAIL
<br />ADDRESS:
<br />INSURER(S) AFFORDING COVERAGE
<br />NAIC#
<br />Pittsburgh PA 15222-3110 USA
<br />INSURED
<br />INSURER A: Zurich American Ins CO
<br />16535
<br />Michael Baker International, Inc
<br />5 Hutton Centre Drive
<br />Suite 500
<br />INSURER B: Allied World surplus Lines Insurance Co
<br />24319
<br />INSURER C: American Guarantee & Liability Ins Co
<br />26247
<br />Santa Ana CA 92707 USA
<br />INSURERD
<br />NSURERE!
<br />INSURER F:
<br />COVERAGES CERTIFICATE NUMBER: 570088962/29 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 REOUIREMENT, 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 />INSD
<br />WV)
<br />POLICY NUMBER
<br />(MMDNYM
<br />I IMODMYYWIILIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />GLO
<br />OCCURRENC
<br />$1,000,000
<br />CLAIMS -MADE OCCUR
<br />PREMISES Ea occurrence)$,
<br />000,000
<br />MED EXP(Any one person)
<br />$10,000
<br />PERSONAL& ADV INJURY
<br />$2,000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />GENERALAGGREGATE
<br />$4,000,000
<br />POLICY ❑X PEQ ❑X TOO
<br />PRODUCTS-COMPIDPAGG
<br />$4,000,000
<br />OTHER:
<br />SIRADetluclible
<br />$250,000
<br />A
<br />AUTOMOBILE LIABILITY
<br />BAP4197284-00
<br />08/30/202108/30/2022
<br />COMBINED SINGLE LIMB
<br />Ea acddenl
<br />2,000, 000
<br />$
<br />BODILY INJURY (Per person)
<br />X ANYAUTO
<br />BODILY INJURY(Pe,acdden0
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />X HIREDAUTOS X NON -OWNED
<br />ONLY AMS ONLY
<br />PROPERTY DAMAGE
<br />Par accident
<br />Dedumble
<br />$100, 000
<br />c
<br />X
<br />UMBRELLALIAB
<br />X
<br />OCCUR
<br />AUCOS3258203
<br />08/30/202108/30/2022
<br />EACH OCCURRENCE
<br />$10,000,000
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />AGGREGATE
<br />$10,000,000
<br />DID I X RETENTION 3I0, 000
<br />A
<br />A
<br />WORKERS COMPENSATION AND
<br />EMPLOYERS'LIABILITY YIN
<br />ANY OFICERIMEMBERETORIEXC UOEO PARTNER IEXECUTIVE IN
<br />(Mandatory in NH)
<br />NIA
<br />WC419728200
<br />AOS
<br />WC419728500
<br />wI
<br />08/30 2021
<br />O8/30/2021
<br />08/30/2022
<br />08/30/2022
<br />X PER STATUTEOTH-
<br />ER
<br />E.L. EACH ACCIDENT
<br />$1,000,000
<br />E.L. DISEASE -EA EMPLOYEE
<br />$1,000,000
<br />If yye desc to antler
<br />DESCRIPTION OF OPERATIONS below
<br />I
<br />E.L. DISEASE POLICY LIMIT
<br />$1,000,006
<br />B
<br />E&O-PL-Primary
<br />03124806
<br />08/3U/2021
<br />08/30/2022
<br />Per Claim
<br />$5,000,000
<br />Claims Made
<br />Aggregate
<br />$5,000,000
<br />SIR applies per policy ter
<br />s & condi
<br />ions
<br />SIR/Deductible (2)
<br />S200,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Addillonal Remarks Schedule, may be 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 policy'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 />CERTIFICATE HOLDER CANCELLATION 922
<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 Ana AUTHORIZED REPRESENTATIVE
<br />Risk Management Division
<br />20 Civic Center Plaza, 4th floor
<br />Santa Ana CA 92702 USA
<br />Rb4 MNrganal Diaidm
<br />I1EVIeLEn 6 API'R(NED Br
<br />01988.2015 ACORD COR RhkMa,uge,rmromwad..
<br />ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD 00
<br />
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