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<br />Ejhjubmmz!tjhofe!cz!Upsj!Qjfstpo! <br />Ebuf;!3133/17/1:!1:;31;27! <br />Upsj!Qjfstpo <br />.18(11( <br />COLI&SO-01BMARIN <br />DATE (MM/DD/YYYY) <br />CERTIFICATE OF LIABILITY INSURANCE <br />5/31/2022 <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 endorsement(s). <br />CONTACT <br />License # 0757776 <br />PRODUCER <br />NAME: <br />PHONEFAX <br />HUB International Insurance Services Inc. <br />(951) 788-8500(951) 788-8502 <br />(A/C, No, Ext):(A/C, No): <br />PO Box 5345 <br />E-MAIL <br />Riverside, CA 92517 <br />ADDRESS: <br />INSURER(S) AFFORDING COVERAGENAIC # <br />Executive Risk Indemnity35181 <br />INSURER A : <br />INSURED <br />Federal Insurance Company20281 <br />INSURER B : <br />INSURER C : <br />Colich & Sons, LP <br />547 West 140th Street <br />INSURER D : <br />Gardena, CA 90248 <br />INSURER E : <br />INSURER F : <br />COVERAGESCERTIFICATE NUMBER: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. <br />INSRADDLSUBRPOLICY EFFPOLICY EXP <br />TYPE OF INSURANCEPOLICY NUMBERLIMITS <br />LTRINSDWVD <br />(MM/DD/YYYY)(MM/DD/YYYY) <br />2,000,000 <br />A <br />COMMERCIAL GENERAL LIABILITY <br />X <br />EACH OCCURRENCE$ <br />DAMAGE TO RENTED <br />100,000 <br />CLAIMS-MADEOCCUR <br />X <br />543101856/1/20226/1/2023 <br />$ <br />X PREMISES (Ea occurrence) <br />5,000 <br />MED EXP (Any one person)$ <br />2,000,000 <br />PERSONAL & ADV INJURY$ <br />4,000,000 <br />GEN'L AGGREGATE LIMIT APPLIES PER:GENERAL AGGREGATE$ <br />PRO- <br />4,000,000 <br />XX <br />POLICYLOC <br />PRODUCTS - COMP/OP AGG$ <br />JECT <br />Per Proj Gen Agg per contract <br />X <br />OTHER:$ <br />COMBINED SINGLE LIMIT <br />2,000,000 <br />B <br />AUTOMOBILE LIABILITY <br />$ <br />(Ea accident) <br />X <br />ANY AUTO 543101846/1/20226/1/2023 <br />BODILY INJURY (Per person)$ <br />X <br />OWNEDSCHEDULED <br />AUTOS ONLYAUTOSBODILY INJURY (Per accident)$ <br />PROPERTY DAMAGE <br />HIREDNON-OWNED <br />(Per accident)$ <br />AUTOS ONLYAUTOS ONLY <br />$ <br />UMBRELLA LIAB OCCUR <br />EACH OCCURRENCE$ <br />EXCESS LIAB CLAIMS-MADE <br />AGGREGATE$ <br />DEDRETENTION$ <br />$ <br />PEROTH- <br />WORKERS COMPENSATION <br />B <br />X <br />STATUTEER <br />AND EMPLOYERS' LIABILITY <br />Y / N <br />543101866/1/20226/1/2023 <br />1,000,000 <br />X <br />ANY PROPRIETOR/PARTNER/EXECUTIVE <br />E.L. EACH ACCIDENT$ <br />N / A <br />OFFICER/MEMBER EXCLUDED? <br />1,000,000 <br />(Mandatory in NH) <br />E.L. DISEASE - EA EMPLOYEE$ <br />If yes, describe under <br />1,000,000 <br />DESCRIPTION OF OPERATIONS belowE.L. DISEASE - POLICY LIMIT$ <br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) <br />RE: Project No. 18-6616; Flower Street Sewer Main Improvements. <br />City of Santa Ana, its officers, employees, agents and representatives are included as Additional Insureds where required by an executed written contract as <br />respects General Liability and Auto Liability per attached endorsements. <br />This Insurance shall apply as Primary and Non-Contributory where required by an executed written contract as respects General Liability and Auto Liability <br />per attached endorsements. <br />Waiver of Subrogation applies where required by an executed written contract as respects WorkersÓ Compensation per attached endorsement. <br />CERTIFICATE HOLDERCANCELLATION <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />City of Santa Ana <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />Risk Management Division <br />20 Civic Center Plaza <br />AUTHORIZED REPRESENTATIVE <br />Santa Ana, CA 92702 <br />ACORD 25 (2016/03)© 1988-2015 ACORD CORPORATION. All rights reserved. <br /> <br />The ACORD name and logo are registered marks of ACORD <br /> <br />