|
9 -aDC~~--/~~ 7
<br />
<br />ACO/?0® CERTIFICATE ~F LIABILITY INSURANCE DATE (MM/DD/WW)
<br />
<br />~/" to/o8/zoo9
<br />PRODUCER
<br />AOn Risk Insurance Services West, Inc. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY
<br />Los Angeles CA Office AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
<br />707 wi 1 shi re Boulevard CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE
<br />Suite 2600
<br />L
<br />A
<br />l
<br />CA 90017
<br />0460 USA COVERAGE AFFORDED BY THE POLICIES BELOW.
<br />nge
<br />-
<br />os
<br />es
<br /> INSURERS AFFORDING COVERAGE NAIC #
<br />PHONE- 866 283-7122 PAX- 847 953-5390
<br />msuRED INSURER A: American International Specialty Lines 26883
<br />Tetra Tech, Inc. INSURERS: insurance Company of the State of PA 19429
<br />16241 Laguna Canyon Rd
<br />.
<br />Irvine CA 92618 USA
<br />INsuRERC: National Union Fire Ins Co of Pittsburgh
<br />19445
<br /> INSURERD Lexington Insurance Company 19437
<br /> INSURER E:
<br />u
<br />,~~',•
<br />^a
<br />~,
<br />u
<br />O
<br />COVERAGES SIR applies per terms and conditions.of the policy "~
<br />THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING
<br />ANY REQUIREMENT, TERM OR CONDITION OF .ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY
<br />PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.
<br />AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LIMITS SHOWN ARE AS REQUESTED
<br />INSR ADD'
<br />LTR INS TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS
<br /> DATE MM/DD/YYYY DATE MM/DD/YYYY
<br />C ENERAL LIABILITY GL4376193 10/01/2009 10/01/2010 EACH OCCURRENCE $1,000,000
<br /> X COMIvDiRCIAL GENERAL LIABII.ITY DAMAGE TO RENTED $100, 000
<br /> PREMISES (Ea occurrence)
<br /> CLAIMS MADE ~ OCCUR MED EXP (Any one person
<br /> X X,C,U Coverage PERSONAL & ADV INJURY
<br />$1,000,000
<br /> GENERAL AGGREGATE $2,000
<br />000
<br /> ' ,
<br /> GEN
<br />L AGGREGATE LIMIT APPLIES PER:
<br />PRODUCTS-COMP/OP AGG
<br />$2,000,000
<br /> ^ POLICY X^ PRO- ~ LOC
<br /> JECT
<br />
<br />C AUTOMOBILE LIABILITY CA 826 33 86 10/01/2009 10/01/2010
<br />COMBINED SINGLE LIMIT
<br /> X pNY pUTp (Ea accident) $ 2 , 000 , 000
<br /> ALL OWNED AUTOS
<br />BODII.Y INJURY
<br /> SCHIiDULED AUTOS (Per person)
<br /> X HIRED AUTOS
<br />BODS.Y INJURY
<br /> X NON OWNED AUTOS x ~~ ~ '1,/ ~ ~ ~~ ~(~ ~
<br />v D * R
<br />1~..LY1 (Per accident)
<br /> PROPERTY DAMAGE
<br /> P
<br />id
<br />
<br />r (
<br />er acc
<br />ent)
<br /> GARAGE LIABILITY ~ _ Y :-, a it I d (I t t Seedy AL1T0 ONLY - EA ACCIDENT
<br /> ANY AUTO ,o.~li?CIl ity Attorne OT}~R TIIpN EA ACC
<br /> AUTO ONLY:
<br /> AGG
<br />D EXCESS /UMBRELLA LIABILFFY TH0900029 10/01/2009 10 O1 2010 EACH OCCURRENCE , ,
<br /> OCCUR ^ CLAIMS MADE AGGREGATE $5,000.000
<br />
<br /> DEDUCTIBLE
<br /> ®
<br /> RETENTION $100,000
<br />B WC 7 1 1 X WC STATU- OTH-
<br />
<br />B WORKERS COMPENSATION AND
<br />wc6987927
<br />10/01/2009
<br />10/01/2010
<br /> EMPLOYERS' LIABILITY E.L. EACH ACCIDENT $1, 000, 000
<br /> ANY PROPRIETOR/PARTNER/EXECUTIVE
<br />OFFICER/MEMI9ER EXCLUDED?
<br />M
<br />d
<br />t
<br />i
<br />NH
<br />E.L. DISEASE-EA EMPLOYEE
<br />$1 , 000 , 000
<br /> (
<br />an
<br />a
<br />ory
<br />n
<br />)
<br />E.L. DISEASE-POLICY LIMIT
<br />$1 , 000 , 000
<br /> If yes, describe under SPECIAL PROVISIONS below
<br />A COP51952583 10/01/2009 each Clain $5,000,000
<br /> OTHER Prof/Poll Liab
<br />Agggregate $5,000,000
<br /> Contractor Prof
<br /> Deductible $250,000
<br />DESCRIPTTON OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
<br />Project: San Lorenzo Sewer Lift Station, 134P00597-0085-00. City of Santa Ana, its officers, agents, volunteers
<br />and representatives are included as Additional Insured with respect to the General Liability policy as required by
<br />written contract. Coverage is Primary and Non-Contributory as respects General Liability policy as required by
<br />CERTIFICATE HOLDER CANCELLATION
<br />Cl ty Of Santa Ana SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
<br />PUb1lC WOrkS Agency DATE THEREOF, THE ISSUING INSURER WIIZ ENDEAVOR TO MAIL
<br />Attn: Steve worrall Project Manager 30 DAYS WRITTEN NOTICE TO TIIE CERTIFICATE HOLDER NAMED TO THE LEFT,
<br />22O S . Ddl 5 AVe . BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY
<br />Y OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES.
<br />Santa Ana CA 92703 u5A
<br />AUTHORIZED REPRESENTATIVE ~~ ~~ ~ ~~~
<br />ACORD 25 (2009/01) ©1988-2009 ACORD CORPORATION. All rights reserve
<br />The ACORD Bame and logo are registered marks of ACORD
<br />m
<br />V
<br />M
<br />O
<br />O
<br />n
<br />O
<br />z
<br />d
<br />r+
<br />R
<br />!:.
<br />.~
<br />U
<br />~:
<br />~_
<br />~IJ
<br />:~
<br />L
<br />
|