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CERTIFICATE OF LIABILITY INSU
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<br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS ON THE Cr_'RT ICA -S�-L� R--tTHIS
<br />CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER T D - 14EU 45CIES
<br />BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BET �4 (t-69WRIZED
<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 LICENSE NO. 0637431
<br />PATRICK MCRAE INSURANCE SERVICES
<br />1265 N. MANASSERO ST. SUITE 303
<br />ANAHEIM HILLS, CA 92807
<br />NAME: ACT PATRICK MCRAE
<br />PHONE t (714) 779-6999 FAX (714) 779-6903
<br />ADDRESS: certrequest@mcraeinsurance.insure
<br />INSURE S AFFORDING COVERAGE
<br />NAIC#
<br />INSURERA: NAVIGATORS SPECIALTY INSURANCE CO.
<br />36056
<br />INSURED
<br />INSURERB: INSURANCE COMPANY OF THE WEST
<br />27847
<br />CROSSTOWN ELECTRICAL & DATA, INC.
<br />5454 DIAZ STREET
<br />IRWINDALE CA 91706
<br />INSURERC: INTEGON NATIONAL INSURANCE COMPANY
<br />29742
<br />INSURERD: ATLANTIC SPECIALTY INSURANCE COMPA
<br />27154
<br />INSURERE: GREAT AMERICAN INSURANCE CO.
<br />16691
<br />INSURER F:
<br />wvr=re wLmo CER iriCAf E Numtstcw REVISION NUM...•
<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 />SUBR
<br />POLICY NUMBER
<br />POLICY EFF
<br />MMIDD/YYYY
<br />POLICY EXP
<br />MM/DD/YYYY
<br />LIMITS
<br />A
<br />X
<br />COMMERCWLGENERAL LIABILITY
<br />X
<br />X
<br />LA21CGLZ04TP71C.
<br />09/03/202109/03/2022
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />CLAIMS -MADE ❑X OCCUR
<br />DEDUCTIBLE $5,000 PER
<br />DDAMAGES R_E_NT D_
<br />PREMISEMEDEXP
<br />$ 1Og000
<br />XCU
<br />OCCURENCE
<br />X
<br />An onepamon)
<br />$ 5,000
<br />X
<br />OGP
<br />PERSONAL S ADV INJURY
<br />$ 1,000,000
<br />GEN'L
<br />AGGREGATE LIMIT APPLIES PER:
<br />GENERAL AGGREGATE
<br />$ 2,000,000
<br />POLICY[K LOG
<br />JEC
<br />PRODUCTS -COMP/OPAGO
<br />$ 2,000,000
<br />EBL
<br />$ 1,000,000
<br />OTHER:
<br />C
<br />AUTOMOBILE
<br />LIABILITY
<br />X
<br />X
<br />2005675448
<br />11/05/202111/05/2022
<br />Ea ecoitleWNGLELIMIT
<br />$ 1,000,000
<br />ANYAUTO
<br />COMP:$1,000
<br />X
<br />BODILY INJURY (Par person)
<br />$
<br />OWNED X
<br />COLL: $1,000
<br />AUTOS ONLY AUTOS
<br />BODILY
<br />BODILY INJURY (Per accident)
<br />$ _
<br />HIRED X NON -OWNED
<br />AUTOS ONLY AUTOS ONLY
<br />X
<br />PROPERTY DAMAGE
<br />Per accident
<br />$ -
<br />E
<br />UMBRELLALIAS
<br />X
<br />OCCUR
<br />TUE257205203
<br />06/03/252109103/2022
<br />EACH OCCURRENCE
<br />$ 10,000,000
<br />EXCESS LIAR
<br />CLAIMS -MADE
<br />UNDERLYING LIMITS:
<br />X
<br />AGGREGATE
<br />$ 10,000,000
<br />GL; AL; EL POLICIES
<br />X 0
<br />DED RETENTION$
<br />$
<br />B
<br />WORKERANDEMPSCOMPEA
<br />x
<br />WVE5030354-07
<br />06/031202206/0312023
<br />X STATUTE ERH
<br />ANDENIPLOTORIPARTNELIABILITY YIN
<br />E.L. EACH ACCIDENT
<br />$ 1,000,000
<br />OF ICEMMEM EREXCLUDEED?ECUTIVE FN]
<br />NIA
<br />E.L. DISEASE - EA EMPLOYEE
<br />$ 1,000,000
<br />(Mandatory in NH)
<br />If yes, descnbe under
<br />E.L. DISEASE - POLICY LIMIT
<br />$ 1,000,000
<br />DESCRIPTION OF OPERATIONS below
<br />D
<br />PROPERTY &
<br />710039414
<br />apip
<br />p
<br />CONTRACTORS
<br />$1.000 DEDUCTIBLE
<br />05/101202
<br />5/10f202
<br />at00B000 ...a oRPremisss
<br />aapo.a reaseeg0
<br />3'WiDao al
<br />COV. INCL. THEFT
<br />DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
<br />CITY OF SANTA ANA IS NAMED AS ADDITIONAL INSURED WITH RESPECTS TO THE ABOVE MENTIONED POLICIES PER ATTACHED
<br />ENDORSEMENT(S). COVERAGE IS PRIMARY & NONCONTRIBUTORY AS REQUIRED BY WRITTEN CONTRACT, PER ATTACHED ENDORSEMENT
<br />FORMS. WAIVER OF SUBROGATION APPLIES, IF REQUIRED BY WRITTEN CONTRACT.
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, A 30 DAY WRITTEN NOTICE WILL
<br />BE ISSUED.
<br />RE: ON CALL CONSTRUCTION SERVICES FOR TRAFFIC SIGNALS, STREET LIGHTS AND CONCRETE WHEELCHAIR RAMPS, PROJECT #RFP NO: 21-
<br />095, JOB #TBD
<br />te�c1
<br />CITY OF SANTA ANA
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />20 CIVIC CENTER PLAZA, M-43 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />SANTA ANA, CA. 92701 ACCORDANCE WITH THE POLICY PROVISIONS.
<br />AUTHORIZED REPRESENTATIVE
<br />f4-J7 Ira,.. �n Riak MnncgmtmtD[Welan
<br />•f I` REnnEwEn &APPROVED By.
<br />©1988-2015 ACORD I w' :. I '; A fe #
<br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD Risk Management Spedalist
<br />
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