|
ACC)RD0® CERTIFICATE OF LIABILITY INSURANCE DA7E(MM1D➢PMY)
<br /> 11/9/2025 11/8/2024
<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 pollcy(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 endorsoment(s).
<br /> PRODUCER Lockton Insurance Brokers,LLC NAM ACT
<br /> CA License#01399399 PHONE FAX
<br /> AIC No):
<br /> 777 S.Figueroa Street,52nd fl. E-MAIL
<br /> Los Angeles CA 90017 ADDRESS:
<br /> 213-689-0065 INSURER(S)AFFORDING COVERAGE NAIC#
<br /> INSURER A:Travelers Property Casualty Company of America 25674
<br /> INSURED Willdan Engineering INSURER B;Allied World Surplus Lines Insurance Company 24319
<br /> 1508060 13191 Crossroads Parkway North, INSURER C
<br /> Suite 405 INSURER D
<br /> City of Industry,CA 91746
<br /> INSURER E;
<br /> INSURER F:
<br /> COVERAGES CERTIFICATE NUMBER: 21138329 REVISION NUMBER: XXXXXXX
<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 I ADDL SUER POLICY EFF POLICY EXP
<br /> TYPE OF INSURANCE
<br /> LTR D POLICY NUMBER (MMIDDIYYYYI IMMIDDIYYYY LIMITS
<br /> COMMERCIAL GENERAL LIABILITY
<br /> A � Y Y P-630-A1178471-TIL-24 11/9I2024 11/9/2025 EACH OCCURRENCE $ 1,()00000
<br /> CLAIMS-MADE F OCCUR DAMAGE TO RENTED $ 1000000
<br /> PREMISES Ea occurrenea
<br /> X Emp.Benefits Liab. MED EXP(Any one person) $ 15,000
<br /> X Con(r.Liab.Incl. PERSONAL&AOV INJURY $ 1,000,000
<br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000
<br /> POLICY IK JEC FX]LOG PRODDOTS-COMPIOPAGG $ 2,000,000
<br /> OTHER: $
<br /> A AUTOMOBILE LIABILITY Y Y 810-Al 161741-24-43-G 11/9/2024 11/9/2025 COMBINED SINGLE LIMIT
<br /> Ea accldent 1 000 000
<br /> X
<br /> ANY AUTO BODILY INJURY(Per person) $ XXXXXX
<br /> OWNED SCHEDULED BODILY INJURY Per accident $ XXXXXXX
<br /> AUTOS ONLY AUTOS ( )
<br /> HIRED NON-OWNED PROPERTY DAMAGE
<br /> AUTOS ONLY AUTOS ONLY Per accldent $ XXXXXXX
<br /> $ XXXXXXX
<br /> UMBRELLA LIAR OCCUR NOT APPLICABLE EACH OCCURRENCE $ XXXXXXX
<br /> EXCESSLIAB CLAIMS-MADE AGGREGATE $ XXXXXXX
<br /> DED I I RETENTION$ $ XXXXXXX
<br /> A AND EMP3COMPENSATIONYERS'LIILIT YIN Y UB-8Y032268-24-43-G 11/9/2024 11/9/2025 X STATUTE ERH
<br /> AND EMPLOYERS'LIABILITY
<br /> ANY PROPRIETOWPARTNEWFXECUTIVE E.L.EACH ACCIDENT -$ 1,000,000
<br /> OFFICER/MEMBER EXCLU➢ED7 ❑N N 1 A
<br /> ---
<br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000
<br /> If yes,describe under
<br /> DESCRIPTION OF OPERATIONS below I E.L.DISEASE-POLICY LIMIT $ 1,000,000
<br /> B Arc1EDg.Prof, N Y 0313-5950 11/9/2024 11/9/2025 Per Claim:$2,000,000
<br /> Aggregate:$2,000,000
<br /> DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
<br /> RE;2025(CB)On-Call Water Resources Construction Management and Inspection Services Agreement No,A-2020-076-02.City of Santa Ana,its officers,officials,employees and volunteers arc
<br /> included as Additional Insureds in accordance with the policy provisions of the General Liability,and Atdomobile Liability policies.A Waiver of Subrogation is granted in favor of City of Santa Ana,
<br /> its offtccrs,officials,employees and volunteers in accordance with the policy provisions of the General,Auto and.Professional LinElity and Workers'Compensation policy.
<br /> CERTIFICATE HOLDER CANCELLATION See Attachments
<br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> 21138329 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br /> City of Santa Ana ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> Attention: Narisa Casuga,Engineering Aide
<br /> 215 S Center Street AUTHORIZED REPRESENTATIVE
<br /> Santa Ana,CA 92703
<br /> ACORD 25(2016103) The ACORD name and logo are registered n APPROVED
<br /> By Cynthia Mora at 9:12 am, Nov 19, 2024
<br />
|