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Francine R. Digitally signed by Francine R.Vill—A
<br />I- _ .. _ _ i Date: 2022.01.141 G0932-08'00'
<br />1 ® Villareal r DATE(MM/DD/YYYY)
<br />ACCORD CERTIFICATE OF LIABILITY INSURANCE
<br />12/18/2021
<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 endorsement(s).
<br />PRODUCER
<br />Los Angeles-Alliant Insurance Services, Inc.
<br />333 S Hope St Ste 3750
<br />Los Angeles CA 90071
<br />CONTACT
<br />NAME: Starlene Carranza
<br />PHONE Ext: 213-406-8750 FAC,No:213-270-0984
<br />E-MAIL
<br />ADDRESS: scarranza@alliant.com
<br />INSURER(S) AFFORDING COVERAGE
<br />NAIC #
<br />INSURERA: Old Republic General Insurance Corp
<br />24139
<br />INSURED GRIFCOM-02
<br />INSURERB: AXIS Surplus Insurance Company
<br />26620
<br />Griffith Company
<br />3050 E. Birch Street
<br />INSURERC:
<br />INSURER D
<br />Brea, CA 92821
<br />INSURER E
<br />INSURER F :
<br />COVERAGES CERTIFICATE NUMBER:555521721 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 />INSR
<br />LTR
<br />TYPE OF INSURANCE
<br />ADDL
<br />INSD
<br />SUBR
<br />WVD
<br />POLICY NUMBER
<br />POLICY EFF
<br />MM/DD
<br />POLICY EXP
<br />MM/DD
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />Y
<br />AlCG99281805
<br />12/31/2021
<br />12/31/2022
<br />EACH OCCURRENCE
<br />$2,000,000
<br />CLAIMS -MADE OCCUR
<br />DAMAGE TO RENTED
<br />PREMISES Ea occurrence
<br />$ 100,000
<br />MED EXP (Any one person)
<br />$ 5,000
<br />PERSONAL & ADV INJURY
<br />$ 2,000,000
<br />GEN'L
<br />AGGREGATE LIMIT APPLIES PER:
<br />GENERAL AGGREGATE
<br />$ 4,000,000
<br />POLICY � PE� LOC
<br />PRODUCTS - COMP/OP AGG
<br />$ 4,000,000
<br />$
<br />OTHER:
<br />A
<br />AUTOMOBILE
<br />LIABILITY
<br />Y
<br />AlCA99281805
<br />12/31/2021
<br />12/31/2022
<br />COEaMBINED ident SINGLE LIMIT
<br />acc
<br />$2,000,000
<br />X
<br />BODILY INJURY (Per person)
<br />$
<br />ANY AUTO
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />BODILY INJURY (Per accident)
<br />$
<br />X
<br />PROPERTY DAMAGE
<br />Per accident
<br />$
<br />HIRED X NON -OWNED
<br />AUTOS ONLY AUTOS ONLY
<br />UMBRELLALIAB
<br />OCCUR
<br />EACH OCCURRENCE
<br />$
<br />AGGREGATE
<br />$
<br />EXCESS LAB
<br />CLAIMS -MADE
<br />DED RETENTION $
<br />$
<br />A
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY Y / N
<br />AlCW99281805
<br />12/31/2021
<br />12/31/2022
<br />X PER OTH-
<br />STATUTE ER
<br />ANYPROPRIETOR/PARTNER/EXECUTIVE
<br />E.L. EACH ACCIDENT
<br />$ 1,000,000
<br />OFFICE R/M EMBER EXCLUDED? FY]
<br />N/A
<br />E.L. DISEASE - EA EMPLOYEE
<br />$ 1,000,000
<br />(Mandatory in NH)
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE - POLICY LIMIT
<br />$ 1,000,000
<br />B
<br />Poll/Prof Liability
<br />CM004236-03-2021
<br />12/31/2021
<br />12/31/2022
<br />Each Claim/Agg
<br />$1,000,000
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required)
<br />Re: Griffith Job #60023, City Project #06-3510, San Lorenzo Sewage Lift Station
<br />The City of Santa Ana, 20 Civic Center Plaza, Santa Ana, California 92701; its officers, employees, agents, volunteers and representatives, Arch Insurance
<br />Company
<br />and JS Held, LLC are named as Additional Insured as respects to Liability arising out of work performed by the Named Insured. The insurance provided shall
<br />be primary and any other insurance maintained by the Additional Insured is excess and non-contributory. Thirty (30) Days Notice of Cancellation / Non -Renewal
<br />— Ten (10) Days Notice For Non -Payment of Premium.
<br />CERTIFICATE HOLDER CANCELLATION
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF,
<br />NOTICE WILL
<br />BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />The City of Santa Ana
<br />20 Civic Center Plaza
<br />Santa Ana CA 92701
<br />AUTHORIZED REPRESENTATIVE
<br />Risk 'Division
<br />(
<br />�e
<br />REVIEWED & APPROVED BY.
<br />© 1988-2015 ACCORD C
<br />mz , VAA44d
<br />ACORD 25 (2016103)
<br />The ACORD name and logo are registered marks of ACORD
<br />��y
<br />Risk Management Analyst
<br />
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