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JAMIIZNU-01
<br />CERTIFICATE OF LIABILITY INSURANCE
<br />SGONZALE
<br />0 3/2YYY)
<br />/2212022024
<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(les) 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 # 0757776Digitally
<br />HUB International Insurance Services Inc.
<br />P Box5345 a Aceved
<br />r511 G1�, 'I%r� Acevedo ■(—�1■
<br />■ ■ Vgi ` i \cev N O Date. 20
<br />��//
<br />.- I iA 1e
<br />PH E FAX
<br />uc,xo,Ezq:(951)779-8763 lAlc,No:(951)231-2572
<br />Ep AIL . cal.cpu@hubinternational.com
<br />ROING COVERAGE
<br />NAIC#
<br />-
<br />INSURER A: The Travelers IndemnityCompany of America
<br />25666
<br />��
<br />INSURED -U / 0
<br />Jamison Engineering Contractors Inc.
<br />2525 S. Yale St.
<br />Santa Ana, CA 92704
<br />INSURER e: Travelers Property Casualty Company of America
<br />25674
<br />INSURER C: State Compensation Insurance Fund of California
<br />35076
<br />INSURERD: Columbia Casualty Company
<br />31127
<br />INSURER E :
<br />INSURER F :
<br />COVERAGES CERTIFICATE NUMBER: 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 />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />INSR
<br />LTR
<br />TYPE OFINSURANCE
<br />ADDLSUBR
<br />POLICY NUMBER
<br />POLICY EFF
<br />POLICY EXP
<br />p
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE X OCCUR
<br />PD Ded: $2,500
<br />X
<br />X
<br />DTC01YO89473TCT24
<br />3/21/2024
<br />3/21/2025
<br />EACH OCCURRENCE
<br />11000,000
<br />DAMAGE TO RENTED
<br />PREMISES(Ea o ce
<br />S00000
<br />X
<br />MEDEXP An one arson
<br />5,000
<br />PERSONAL &ADV INJURY
<br />S 1,000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />POLICY �X JECT LOG
<br />GENERAL AGGREGATE
<br />2,000,000
<br />PRODUCTS -COMP/OPAGG
<br />2,000,000
<br />OTHER:
<br />A
<br />AUTOMOBILE
<br />LIABILITY
<br />COMBINED SINGLE LIMIT
<br />Ea accident
<br />1000000
<br />$
<br />BODILY INJURY Perperson)
<br />$
<br />X
<br />ANY AUTO
<br />X
<br />BAlYO902142426G
<br />3/2112024
<br />3121/2025
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />BODILY INJURY Per accident
<br />$
<br />PROPERTYDAMAGE
<br />Per accident
<br />$
<br />X
<br />X
<br />HIRED X NON -OWNED
<br />AUTOG ONLY AUTOS ONLY
<br />Comp & Cell X Ded $1,000
<br />B
<br />UMBRELLA LIAB
<br />X
<br />OCCUR
<br />EACH OCCURRENCE
<br />$ 5,000,000
<br />X
<br />EXCESS LWB
<br />CLAIMS -MADE
<br />CUPl YO907242426
<br />3/2112024
<br />3/21/2025
<br />AGGREGATE
<br />5,000,000
<br />DEO X RETENTION$ 0
<br />C
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY YIN
<br />AN V PROPRIETORIPARTNERIEXEcuTIVE
<br />�pFISER/MEMBER EXCLUDED?
<br />(Mandatary In NH)
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />NIA
<br />X
<br />90374962024
<br />111/2024
<br />1l1/2025
<br />X PER OTH-
<br />STATUTE E
<br />EL EACHACCIDENT
<br />1,ppp,pOp
<br />$
<br />EL DISEASE -EA EMPLOYEE
<br />$ 1,000,000
<br />E.L. DISEASE -POLICY LIMIT
<br />1,000,000
<br />$
<br />D
<br />E&O Liab SIR: $5,000
<br />CE06057126128
<br />3/2112024
<br />3121/2025
<br />Ea Incident & Agg
<br />2,000,000
<br />DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101, Additional Remarks Schedule, may be adached IF more space is required)
<br />Excess Liability Policy following underlying policies: GL, Auto, WC Only
<br />RE: On Call Services.
<br />City of Santa Ana, officers, agents, employees, representatives and volunteers are Additional Insured with regard to General Liability when required by written
<br />contract per the attached endorsement forms CGD361 03105 and CG2037 07104. Primary & Non -Contributory wording applies with regard to General Liability
<br />when required by written contract per the attached endorsement form CGT100 02119. Waiver of Subrogation applies to the General Liability policy, when
<br />required by written contract, per the attached endorsement form CGD316 02/19. Additional Insured with regard to Auto Liability when required by written
<br />SEE ATTACHED ACORD 101
<br />SHOULD ANY OF THE ABOVE DESCF
<br />Cityof Santa Ana
<br />Risk Management Division
<br />THE EXPIRATION DATE THERM
<br />ACCORDANCE WITH THE POLICY PR
<br />20 Civic Center Plaza
<br />AUTHORIZED
<br />�jE R QEPPPR�ESENTATIVE
<br />krurizaJ
<br />Santa Ana, CA 92702
<br />ACORD 25 (2016/03) ©1988-2015 ACORD
<br />The ACORD name and logo are registered marks of ACORD
<br />IPn
<br />q,ssyy wKmaoalgenuaa. vnmian
<br />a" _ RENEWE A+� Acwu(a
<br />Rbk Management Specialist
<br />
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