|
Holder Identifier : 7777777707070700077761616045571110776617006304557307553127673506210073641577147321120763415546177555207026100677235553074626231325277600754263357607677607704011752274530076727242035772000777777707000707007 7777777707070700073525677115456000733101507137103007122337352063001070332372420631110703222624306311107033237242073110070233373520731010702233635207311007023226253073111077756163351765540777777707000707007Certificate No : 570110778516 CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY)
<br /> 02/05/2025
<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 />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 />PRODUCER
<br />Aon Risk Services Central, Inc.
<br />Pittsburgh PA Office
<br />EQT Plaza ~ Suite 2700
<br />625 Liberty Avenue
<br />Pittsburgh PA 15222-3110 USA
<br />PHONE(A/C. No. Ext):
<br />E-MAILADDRESS:
<br />INSURER(S) AFFORDING COVERAGE NAIC #
<br />(866) 283-7122
<br />INSURED 24319Allied World Surplus Lines Insurance CoINSURER A:
<br />16535Zurich American Ins CoINSURER B:
<br />26247American Guarantee & Liability Ins CoINSURER C:
<br />INSURER D:
<br />INSURER E:
<br />INSURER F:
<br />FAX(A/C. No.):(800) 363-0105
<br />CONTACTNAME:
<br />Michael Baker International, Inc
<br />5 Hutton Centre Drive
<br />Suite 500
<br />Santa Ana CA 92707 USA
<br />COVERAGES CERTIFICATE NUMBER:570110778516 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 />Limits shown are as requested
<br />POLICY EXP (MM/DD/YYYY)POLICY EFF (MM/DD/YYYY)SUBRWVDINSR LTR ADDL INSD POLICY NUMBER TYPE OF INSURANCE LIMITS
<br />COMMERCIAL GENERAL LIABILITY
<br />CLAIMS-MADE OCCUR
<br />POLICY LOC
<br />EACH OCCURRENCE
<br />DAMAGE TO RENTED
<br />PREMISES (Ea occurrence)
<br />MED EXP (Any one person)
<br />PERSONAL & ADV INJURY
<br />GENERAL AGGREGATE
<br />PRODUCTS - COMP/OP AGG
<br />X
<br />X
<br />X X
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />$2,000,000
<br />$1,000,000
<br />$10,000
<br />$2,000,000
<br />$4,000,000
<br />$4,000,000
<br />$250,000Deductible
<br />B 08/30/2024 08/30/2025GLO419728103
<br />PRO-
<br />JECT
<br />OTHER:
<br />AUTOMOBILE LIABILITY
<br />ANY AUTO
<br />OWNED
<br />AUTOS ONLY
<br />SCHEDULED
<br /> AUTOS
<br />HIRED AUTOS
<br />ONLY
<br />NON-OWNED
<br />AUTOS ONLY
<br />BODILY INJURY ( Per person)
<br />PROPERTY DAMAGE
<br />(Per accident)
<br />X
<br />X X
<br />BODILY INJURY (Per accident)
<br />$2,000,000B08/30/2024 08/30/2025
<br />$100,000
<br />COMBINED SINGLE LIMIT
<br />(Ea accident)BAP 4197284 03
<br />Deductible
<br />EXCESS LIAB
<br />X OCCUR
<br />CLAIMS-MADE AGGREGATE
<br />EACH OCCURRENCE
<br />DED
<br />$10,000,000
<br />$10,000,000
<br />$10,000
<br />08/30/2024UMBRELLA LIABC 08/30/2025AUC053258206
<br />RETENTIONX
<br />X
<br />E.L. DISEASE-EA EMPLOYEE
<br />E.L. DISEASE-POLICY LIMIT
<br />E.L. EACH ACCIDENT $1,000,000
<br />X OTH-ERPER STATUTEB08/30/2024 08/30/2025
<br />AOS
<br />WC419728503B 08/30/2024 08/30/2025
<br />$1,000,000
<br />Y / N
<br />(Mandatory in NH)
<br />ANY PROPRIETOR / PARTNER /
<br />EXECUTIVE OFFICER/MEMBER N / AN
<br />WI
<br />WORKERS COMPENSATION AND
<br />EMPLOYERS' LIABILITY
<br />If yes, describe under DESCRIPTION OF OPERATIONS below
<br />$1,000,000
<br />WC419728203
<br />Per Claim0312480608/30/2024 08/30/2025
<br />Claims Made $5,000,000Aggregate
<br />SIR $200,000
<br />E&O - Professional Liability -
<br />Primary
<br />A
<br />SIR applies per policy terms & conditions
<br />$5,000,000
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
<br />RE: MB Project Name: Environmental Services and Technical Studies, Agreement A-2020-076-05A. The City of Santa Ana, its
<br />officers, officials, employees and volunteers are included as Additional Insured in accordance with the policy provisions of
<br />the General Liability and Automobile Liability policies. General Liability policy evidenced herein is Primary and
<br />Non-Contributory to other insurance available to Additional Insured, but only in accordance with the policy's provisions. A
<br />Waiver of Subrogation is granted in favor of the City of Santa Ana in accordance with the policy provisions of the General
<br />Liability, Automobile Liability, Umbrella Liability, Professional Liability and Workers' Compensation policies.
<br />CANCELLATIONCERTIFICATE HOLDER
<br />AUTHORIZED REPRESENTATIVECity of Santa Ana
<br />Attn: Water Resources Division (M85)
<br />215 S Center St.
<br />Santa Ana CA 92703 USA
<br />ACORD 25 (2016/03)
<br />©1988-2015 ACORD CORPORATION. All rights reserved
<br />The ACORD name and logo are registered marks of ACORD
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
<br />DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS.
|