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Client#: 90342
<br />ACORD. CERTIFICATE OF LIABILITY INSU
<br />Ulyftduy signea
<br />by A ne�7�
<br />IM
<br />CERTIFICATE DOES NOT AFTHIS CERTIFICATE 15 FIRMATIVELY VE YASA EOR NEGATIVELYR OF IAMEND, XTEND OR ALTER ON ONLYAND CONFERS NOTHE COVERAGE AFFFOADl Eo A Ef '�OLIC4S6
<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 any rights to the certificate holder in lieu of such endorsement(s).
<br />PRODUCER CONTACT
<br />NAME: ferry NOyola
<br />Greyling Ins. Brokerage/EPIC ,CNN E,t: 770-220-7699 ac Na:
<br />3780 Mansell Road, Suite 370 E-MAIL oa,.� re Iln
<br />ADDRESS :]er rynol@ y 9 Y g•com
<br />Alpharetta, GA 30022 INSURER(S) AFFORDING COVERAGE NAIC#
<br />INSURED
<br />PGH Wong Engineering, Inc.
<br />182 2nd St. Suite 500
<br />San Francisco, CA 94105
<br />Hartford Fire Insurance Co.
<br />Hartford Casualty Ins. Co.
<br />Property AN Casualty Ins Co of Hartford
<br />Starr Surplus Lines Insurance Company
<br />Twin City Fire Insurance Co.
<br />a.uvcrcwoco "MilrluAICNUMDCK: AI-[L REVISION NUMBER:
<br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FORTHE POLICY PERIOD
<br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR 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 />rypE OF INSURANCE
<br />ADD
<br />INSIR
<br />SUER
<br />MID
<br />POLICY NUMBER
<br />POLICYEFF
<br />MMIDD
<br />POLICY EXP
<br />MMIDD
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />CLAIMS-MADEEi� OCCUR
<br />20UENOK8022
<br />12/18/2021
<br />12/18/2022
<br />EACHOCCURRENCE
<br />$1,000,000
<br />PRESEocuaMEppcnnce
<br />s30111,000
<br />MED EXP (Any one person)
<br />$10,000
<br />PERSONAL &ADV INJURY
<br />$1,000,000
<br />GEN'L
<br />AGGREGATE LIMIT APPLIES PER:
<br />RO-
<br />POLICY I d CT � LOC
<br />GENERAL AGGREGATE
<br />s2,000,000
<br />PRODUCTS -COMPIOPAGG
<br />$2,000,000
<br />I
<br />$
<br />OTHER:
<br />I
<br />E
<br />AUTOMOBILE
<br />LIABILITY
<br />20UENOK8020
<br />M18/2021
<br />12/18/202
<br />COMBINED SINGLE LIMIT
<br />Ea accident
<br />1,000,000
<br />BODILY INJURY(Par person)
<br />$
<br />ANY AUTO
<br />IX
<br />OWNED SCHEDU
<br />AUTOS ONLY AUTO
<br />RY Per accidentLED BODILY INJU
<br />( )HIRED
<br />$
<br />NON N
<br />AUTOS ONLY X AUTOSS ONLYLY
<br />PROPERTY DAMAGE
<br />Per accident
<br />$
<br />B
<br />X
<br />UMBRELLA LIAB
<br />](
<br />OCCUR
<br />20XHUOK8027
<br />12/18/2021
<br />12/1812022
<br />EACH OCCURRENCE
<br />$10000000
<br />AGGREGATE
<br />$10 000 000
<br />EXCESS LIAR
<br />CLAIMS -MADE
<br />DED X RETENTION$10000
<br />$
<br />C
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY YIN
<br />ANY PROPRIETORIPARTNERIEXECUTIVE
<br />OFFICERIMEMBER EXCLUDED? �
<br />NIA
<br />20WEOK8H05
<br />12/78/2021
<br />12/18/202
<br />X PER OH.
<br />STATUTE
<br />E.L. EACH ACCIDENT
<br />$1,000000
<br />E.L. DISEASE - EA EMPLOYEE
<br />$1,000000
<br />(Mandator, In NH)
<br />0 o, describe under
<br />DESCRIPTION OF OPERATIONS ImIme
<br />E.L. DISEASE - POLICY LIMIT
<br />$1,000,000
<br />D
<br />Prof. Liab. incl.
<br />1000633873211
<br />12/18/2021
<br />12/18/202
<br />Per Claim $10,000,000
<br />Pollution Liab.
<br />Aggregate $10,000,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached R more space is required)
<br />Re: 1000 East Santa Ana Blvd., Ste. 220, Santa Ana 92701. The City of Santa Ana, its officers, employees,
<br />agents, volunteers & representatives are named as Additional Insureds with respects to General Liability
<br />where required by written contract. The above referenced liability policies with the exception of workers
<br />compensation and professional liability are primary & non-contributory where required by written contract.
<br />Waiver of Subrogation is applicable where required by written contract & allowed by law. Should any of the
<br />(See Attached Descriptions)
<br />City of Santa Ana SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />Risk Management Division ACCORDANCE WITH THE POLICY PROVISIONS.
<br />20 Civic Center Plaza
<br />4th Floor AUTHORIZED REPRESENTATIVE
<br />Santa Ana, CA 92701 �/ R1deMnuganvltDivielml
<br />REVIEWED&APPROVED BY:
<br />m 1988-2015 ACORC �� A+g:.r Abwuca
<br />ACORD 25 (2016/03) 1 of 2 The ACORD name and logo are registered marks of ACORD X�M=__ Risk Management specialist
<br />#S3345735/M3021784
<br />
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