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i—"/ ® DATE(MMIDD/YYYY)
<br /> AFRO CERTIFICATE OF LIABILITY INSURANCE 05/22/2024
<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 zo
<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.If
<br /> SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this 4w—'
<br /> certificate does not confer rights to the certificate holder in lieu of such endorsement(s). .c
<br /> PRODUCER CONT.0 • • . L
<br /> Aon Risk Services ntral, Inc. NAME: ]/yz�3 I��'2z \' signed
<br /> >_
<br /> Chicago IL Office (A/C. o.Ext �1.I� l2`a 1 " 9
<br /> 200 East Randal E-MA 1
<br /> Chicago IL 6060p ngie ADDR'�S: , _
<br /> _ A r� e°AGcev e d o NAIL#
<br /> INSURED INS)' ER, Arch urance company 11150
<br /> Walsh Construction company II, LLC IN£ KERB:Ouch ndemnit n r ce amp y 0830
<br /> 1260 Corona Point ourt Ste 201 ate••
<br /> Corona CA 42879 u I, SURER C:
<br /> C e v e o ,Ns'uR;H D:
<br /> INSURER E: 1� . ^soot
<br /> INSURER F: w
<br /> COVERAGES CERTIFICATE NUMBER: 57(10',d06543 -• ' �ON NR: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. Limits shown are as requested
<br /> INSR ADDL SUBR POLICY EFF POLICY EXP
<br /> LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER (MM/DD/YYYY) IMM/DDIYYYY1 LIMITS
<br /> A X COMMERCIAL GENERAL LIABILITY 41PKG8901918 06/O1/2024 06/01/2025 EACH OCCURRENCE $2,000,000
<br /> CLAIMS-MADE X OCCUR SIR applies per policy terns & conditions DAMAGE TO RENTED $1,000,000
<br /> PREMISES(Ea occurrence)
<br /> MED EXP(Any one person) $2 5,000
<br /> PERSONAL&ADV INJURY $2,000,000 7
<br /> GEN'LAGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $4,000,000 0
<br /> POLICY I X I�E X LOC CT PRODUCTS-COMP/OP AGG $4,OOO,OOO o
<br /> OTHER: o
<br /> r`
<br /> A 41PKG8901918 06/01/2024 06/01/2025 COMBINED SINGLE LIMIT `r'
<br /> AUTOMOBILE LIABILITY $5,000,000
<br /> AOS (Ea accident) ,,
<br /> A X ANY AUTO 41CAB8902018 06/01/2024 06/01/2025 BODILY INJURY(Per person) Z
<br /> —
<br /> OWNED SCHEDULED MA only BODILY INJURY(Per accident) N
<br /> AUTOS ONLY AUTOS
<br /> HMEDAUTOS NON-OWNED PROPERTY DAMAGE Ti
<br /> ONLY AUTOS ONLY (Per accident) w
<br /> w
<br /> - d
<br /> A UMBRELLALIAB X OCCUR 41UFP1992101 06/01/2024 06/01/2025 EACH OCCURRENCE $5,000,000 V
<br /> X EXCESS LIAB CLAIMS-MADE AGGREGATE $5,000,000
<br /> DED RETENTION
<br /> B WORKERS COMPENSATIONAND 44WC18937511 06/01/2024 06/01/2025 X PER STATUTE OTH-
<br /> EMPLOYERS'LIABILITY Y/N A05 ER
<br /> ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT 51,990,009
<br /> /M A OFFICEREMBEREXCLUDED? N N/A 41WC18910411 06/01/2024 06/01/2025
<br /> (Mandatory in NH) FL E.L.DISEASE-EA EMPLOYEE 51,000,000
<br /> If yes,describe under
<br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000—
<br /> A Excess workers compensation 41WCX8901818 06/01/2024 06/01/2025 EL Each Accident $1,000,000
<br /> IL,IN,WA,OH EL Disease - Policy $1,000,000
<br /> SIR applies per policy terns & condi-ions EL Disease - Ea Bap. $1,000,000
<br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required)
<br /> Re: Encroachment Permit, Job 218132. _---
<br /> See Attached.
<br /> /r....i
<br /> M
<br /> CERTIFICATE HOLDER CANCELLATION
<br /> ed
<br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
<br /> EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE -r.rd
<br /> POLICY PROVISIONS.
<br /> City of Santa Ana, M-93 AUTHORIZED REPRESENTATIVE
<br /> 20 Civic Center Plaza
<br /> Santa Ana CA 92702 USA t o�2 cJ�V ( RieltMnrmgefPROV iDBy:
<br /> ��tL_YG/l r,oa..t�
<br /> ie444a1 y REVIEWED&APPROVED BY:
<br /> al1n1111►�c' A4 Acwes4 '
<br /> ®. Risk Management Specialist
<br /> ©1988-2015 ACORD CC,
<br /> NA
<br /> ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD
<br />
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