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ACORD 25 (2016103)
<br />mM'N`rnynea'1 viermn
<br />_ Tori Pierson -0;=e= es.3e ==e3e
<br />DATE(MM/DD/YYYY)
<br />�- CERTIFICATE OF LIABILITY INSURANCE 08/30/2021
<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 />SUBROGATION IS WAIVED, subject tthe 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 Ilea of such entlorsementlsl.
<br />n Risk Services Central, Inc.
<br />ttsburgh PA Office
<br />T Plaza - Suite 2700
<br />5 Liberty Avenue
<br />ttsburgh PA 15222-3110 USA
<br />Michael Baker International, Inc
<br />5 Hutton Centre Drive
<br />Suite 500
<br />Santa Ana CA 92707 USA
<br />(866)
<br />INSURERS) AFFORDING COVERAGE
<br />(rich American Ins Co
<br />INSURER B: Allied N
<br />INSURER C: American
<br />INSURER D:
<br />INSURER E:
<br />INSURER F:
<br />363-0105
<br />N
<br />insurance
<br />novlavary IvumnEri:
<br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED
<br />ABOVE FOR THE POLICY PERIOD
<br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT
<br />WITH RESPECT TO WHICH THIS
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN
<br />IS SUBJECT TO ALL THE TERMS,
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />Limits shown are as requested
<br />LTR
<br />A
<br />TYPE OF INSURANCE
<br />INSD
<br />WVD
<br />POLICY NUMBER
<br />MM/DDIVYYY
<br />MMroD/YVYY
<br />LIMITS
<br />X COMMERCIAL GENERAL LIABILITY
<br />GLO
<br />EACH OCCURRENCE
<br />$2,000,000
<br />CLAIMS -MADE ❑X OCCUR
<br />TED
<br />$1, OOOr000
<br />Ea ocourrenca
<br />(Any one pamon)
<br />$10, 000
<br />L a ADV INJURY
<br />$2,000,000
<br />GEMLAGGREGATE LIMITAPPLIES PER:
<br />POLICY ❑X PRO- E LOS
<br />AGGREGATE
<br />MSINGLE
<br />$4 r 000,000
<br />S-COMP/OPAGG
<br />$4,000,000
<br />JECT
<br />OTHER:
<br />tible
<br />$250, G00
<br />A
<br />AUTOMOBILE LIABILITY
<br />BAP4197284-00
<br />OS/30/202108/30/2022SINGLE
<br />LIMITt
<br />$2, 000, 000
<br />X ANYAUTO
<br />BODILY INJURY( Per Person)
<br />OWNED pUTOSDLED
<br />AUTOS ONLY
<br />BODILY INJURY(Pe(accldent)
<br />X HIRED AUTOS X NONOWNEDPROPERTY
<br />DAMAGE
<br />ONLY AUTOS ONLY
<br />Per accident
<br />D
<br />Dedudlblo
<br />$100, 000
<br />X UMBRELLA LIAR X OCCUR
<br />A00053258203
<br />OB 30/2021
<br />08/30 2022
<br />EACH OCCURRENCE
<br />$10, 000, 000
<br />EXCESS LIAR CLAIMS -MADE
<br />AGGREGATE
<br />$10,000,000
<br />DED X RETENTION $10.000
<br />A
<br />WORKERS COMPENSATION AND
<br />EMPLOYERS' LIABILITY
<br />WC419728200
<br />08/30 2021
<br />08 30/2022
<br />X PER STATUTE 0TH-
<br />A
<br />YIN
<br />ANY PROPRIETOR/PARTNER/EXECUTIVE
<br />A05
<br />E
<br />E.L.EACH ACCIDENT
<br />E1r000, 000
<br />N
<br />OFFICERIMEMBER EXCLUDED9 ❑
<br />NIA
<br />WC419728500
<br />08/30/2021
<br />08/30/2022
<br />If (MandatoryInNH)
<br />If Yes tlescdba antler
<br />WE
<br />E.L. DISEASE EA EMPLOYEE
<br />$l, 000, 000
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. OISEASEPOLICV LIMIT
<br />$1, 000, 000
<br />B
<br />E&O-PL-Primary
<br />s0
<br />08/30/202I
<br />08/30/2022
<br />Per claim
<br />55,000, 000�
<br />claimM
<br />claims Made
<br />Aggregate
<br />$5 000,00 01
<br />SIR applies per policy ter
<br />s & condi
<br />ions
<br />SIR/Deductible (2)
<br />,
<br />$200,000:
<br />DESCRIPTION OF OPERATIONS/ LOCATIONS I VEHICLES (,CORD 101, Adtlleo m, Remarks Schetlule, may be altachetl If more apace le requlretl)
<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 Additional
<br />as 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
<br />Additional Insured, but only in accordance with the pof icy's provisions. should General
<br />Liability, Automobile Liability, Professional Liability and Workers' Compensation be before
<br />policies cancelled the expiration
<br />date thereof, the policy provisions will govern how notice of cancellation may be delivered to Certificate Holders in
<br />accordance wl th the policy provisions.
<br />e
<br />k AIVUCLLAI IUN L�
<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
<br />Risk Management Division
<br />20 Civic Center Plaza, 4th floor
<br />Santa Ana CA 92702 USA I ,�/J I('_Z2 '
<br />����y �"J .s Ria4AtnugplmlLiXWdm
<br />`' Rsv1L''ABD & ArrpovEo Br,
<br />©195,CORD CDR
<br />The ,CORD name and logo are registered marksks of %RtAnadre
<br />of ,CORD Ruk`ma9.wmCI W.IAid,
<br />
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