BUCKNAM INFRASTRUCTURE GROUP, INC.

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T ' p- Digitally Lgnmb TWPiewn Orl Jerson Dxe: xon.n.ag udmx4 ea'Ce ACC) o CERTIFICATE OF LIABILITY INSURANCE DAM(MM/DDNYYY) 9/30n021 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 REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) 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 CONTACT NAME: WTW MIDWEST INC PHONE (888)780-5381FAX A/C No: (866 828-2424 AIL ADDRESS: Certificate@Hanover.CDm 233 S WACKER DR,SUITE 2000 CHICAGO IL 60606 INSURERS AFFORDING COVERAGE NAIC M INSURERA: Citizens Ins Cc of America 31534 INSURED INSURER B: Hanover Insurance CO 22292 INSURER C: Hanover American ins Cc 36064 INSURER D: BUCKNAM INFRASTRUCTURE GROUP INC 3548 SEAGATE WAY STE 230 INSURER E : OCEANSIDE CA 92056 INSURER F: GOVERAGES CERTIFICATE NUMBER: RFVIRInPJ NLI$$RFR- 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 AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADOL Imen SUER WVD POLICYNUMBER POLICY EFF MM/DD POLICY EXP MMIDD LIMITS COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR EACH $ 2,000,000 DAMAGE TORRENCE PREMISES Ea occunence $ 1'000,000 MED EXP (Mn one person) $ 10,000 PERSONAL&ADV INJURY $ 2.000,000 A Y Y OBC A399956 07 09/16/2021 09/16/2022 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY W] PRO- ❑ JECT LOC GENERALAGGREGATE $ 4,000,000 PRODUCTS-COMP/OPAGG $ 4,000,000 $ OTHER: AUTOMOBILE LIABILITY COELI MBINED SINGLMIT Ea accident $ 2,000,000 BODILY INJURY (Par person) $ ANY AUTO A OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON�WNE AUTOS ONLY AUTOS ONLY N N OBC A39995607 09/16/2021 09/16/2022 BODILY INJURY Per accident ( ) $ PROPERTY DAMAGE Per amident $ ✓ UMBRELUUAS 6 OCCUR EACH OCCURRENCE $ 3,000,000 AGGREGATE $ 3,000,000 A EXCESS LIAB CLAIMS-MAOE Y Y OBC A399956 07 09/16/2021 09/16/2022 DED RETENTION$ $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANYPROPRIETORIPAROFHCERIM MB REXCLUDEO ECUTIVE (Mandatory In NH) yes descdbe antler NIA N WZC A39994607 09/16/2021 09116/2022 PER OTH- STATUTE ER E.L. EACH ACCIDENT $ 1,000,000 E.L. pISEASE-EAEMPLOVEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT $ 1,000,000 0,S6If DESCRIPTION OF OPERATIONS below B Architects & Engineers Prof Uab N N LHC H023717 02 09/16/2021 09/16/2022 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) The City of Santa Ana, its officers, officials, employees, and volunteers are Additional Insured on the General Liability pursuant to the terms and Conditions by form 391-1586. Additional Insured is Primary and Noncontributory to the extent provided by form 391-1003 (pg 79 of 81). Waiver of Subrogation as provided by form 391-1003 (pg 80 of 81). Cancellation Notice will be provided to the Certificate Holder pursuant to endorsement: 401-1235. Such notice is solely for the purpose of informing the Certifcate Holder of the effective date of cancellation and does not grant, alter, or extend any rights or obligations under this policy. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. CITY OF SANTA ANA 20 CIVIC CENTER PLAZA (M-30) AUTHORIZEDREPRESENTATWE PO BOX 1988 SANTA ANA CA 92702 '-i}LI,CR.v,"fv-1�41, - 76'P&W., Ruk Managrnarl UmuiPiJe @ 1988.2015 ACORD CORF ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD