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p Digitally signed by
<br />A Il g I IGALIFf FJPrA% Aceve KRI TYB
<br />'4� o CERTIFICATE OF LIABILITY 1 F Date:2022.0 .02DATEIMINDD/YYYYI
<br />7/21/2022
<br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHT:4 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)i 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 License # 0252636
<br />C TACT Kristy Braley
<br />United Agencies
<br />3257 E. Guasti Ave, Suite 100
<br />Ontario, CA 91761
<br />PHONE
<br />(A/C, No, E.ei: ac, No
<br />E'^A'L . kris ty drisinc.com
<br />INSURERS AFFORDING COVERAGE NAIC#
<br />INSURERA: Navi nini $ npany
<br />36056
<br />INSURED
<br />INSURER B:Travelem Property Casualty Company of America
<br />25674
<br />INSURERC:RSUI Indemnity Company
<br />22314
<br />California Professional Engineering Inc.
<br />19062 San Jose Avenue
<br />La Puente, CA 91748
<br />INSURERD:Travelers Casualty and Sure Com an
<br />19038
<br />INSURER E
<br />NSURER F:
<br />COVERAGES rFRTIPIrATI=lin R11DDD.
<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 />rypE OF INSURANCE
<br />ADDL
<br />SUBR
<br />POLICY NUMBER
<br />POLICY EFF
<br />PO LICYEXP
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />CLAIMS -MADE ❑X OCCUR
<br />X
<br />X
<br />CE22CGL2395411C
<br />5/19/2022
<br />5/19/2023
<br />DAMAGE TO RENTED
<br />50,000
<br />Owner's & Contractor
<br />X
<br />MED EXP An one arson
<br />$
<br />PERSONAL &ADV INJURY
<br />$ 1,000,000
<br />GEN'L AGGREGATE LIMIT � APPLIES PER:
<br />�
<br />GENERAL AGGREGATE
<br />$ 2,000,000
<br />PRODUCTS-COMP/OP AGG
<br />$ 2,000,000
<br />POLICY JECT LOC
<br />$
<br />OTHER:
<br />B
<br />AUTOMOBILE LIABILITY
<br />COMaBINtlED SINGLE LIMIT
<br />(EaX
<br />$ 1,000,000
<br />BODILY INJURY Per poomol
<br />$
<br />ANY AUTO
<br />X
<br />X
<br />4N2618072226G
<br />511912022
<br />511912023
<br />OPMED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />BODILY INJURY Per accident
<br />8
<br />1
<br />AU X TOAUOTOSS ONLY X ONES
<br />PeOr accR�ni AMAGE
<br />$
<br />X Ded:$D
<br />C
<br />UMBRELLA LIAB X OCCUR
<br />EACH OCCURRENCE
<br />$ 6,000,000
<br />X EXCESS LIAB CLAIMS -MADE
<br />X
<br />NHA253783
<br />5119/2022
<br />511912023
<br />AGGREGATE
<br />§ 6,000,000
<br />DED I X I RETENTION$ 10,000
<br />B
<br />WORKERS COMPENSATION
<br />X PER OTH.
<br />$
<br />AND EMPLOYERS' LIABILITY
<br />ANY PROPRIETORMARTN ER ECUTIVE YIN
<br />X
<br />3NO999432226G
<br />5/1912022
<br />5119/2023
<br />E. L EACH ACCI DENT
<br />$ 1,000,000
<br />EXCLUDED? ❑Y
<br />ppF�FICERry In NH)
<br />NIA
<br />E.L. DISEASE - EA EMPLOYEE
<br />$ 1,000,000
<br />If es, atoryln be ander
<br />E. L. DISEASE -POLICY LIMIT
<br />$ 1,000,000
<br />DESCRIPTION OF OPERATIONS below
<br />D
<br />Contractor Equipment
<br />7P2991896600
<br />5/1912022
<br />5/19/2023
<br />Leased/Rented
<br />100,000
<br />D
<br />Installation Floater
<br />7P2991896600
<br />5/19/2022
<br />5119/2023
<br />Limit
<br />250,000
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLE$ IACORD 101, Additional Remarks Schedule, maybe aaached a mores ace Is reuiretl
<br />NO.: 21.095 ON -CALL CONSTRUCTION SERVICES FOR TRAFFIC SIGNALS, STREET LIGHTS AND CONCRETEqWHEELCHAIR RAMPS
<br />The CiTy, its officers, officials, employees, and volunteers are to be covered as additional insureds respect to General Liability per forms CG20100413 &
<br />CG20370413 and Auto Liability per form CAT3530817. This insurance is primary and non-contributory with respect to General Liability per form CG20010413 &
<br />Auto Liability perform CAT4740216.
<br />'At least thirty (30) days notice of cancellation. Ten (10) days notice for non-payment of premium.
<br />Clerk of the City Council
<br />City of Santa Ana
<br />20 Civic Center Plaza (Ii
<br />P.O. Box 1988
<br />Santa Ana, CA 92702-1988
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />AUTHORIZED REPRESENTATIVE
<br />qA-
<br />ACORD 25 (2016/03) ©1988-2015 ACORD
<br />The ACORD name and logo are registered marks of ACORD
<br />�'K'
<br />Risk MDugemad Division
<br />REVIEWED&APPROVE) BY.'
<br />MWE
<br />A-fl A:w44
<br />Risk Management Specialist
<br />
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