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DATE (MM/DD/YYYY) ACORDrM CERTIFICATE OF LIABILITY INSURANCE 4ili2oo9 4ni2oos PRODUCER ~Lockton Companies, LLC-L Los Angeles THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION • 19800 MacArthur Blvd., Suite 550 ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE CA License #OF15767 ALOTER THE COVERAGE A FORDED BYOTHE PPO DC ES BELOW. Irvine CA 92612 ~(~ 949-252-4400 ~ _ ~ OIV- -Q 77 VERAGE NAIC # INSURED Metcalf & Eddy, Inc. ~' - e(D ~ '!~2 U 1.075642 999 Town & Country Road 0 ~S _ Q33 Orange CA 92868 Q - .2 COVERAGES AECTE01 OE INSURERS AFFORDING CO wsuRERA: New Hampshire Insurance Company 23841 INSURER B : Insurance Company of the State of PA 19429 INSURER C INSURER D INSURER E : _ _ __ _ __ ____,__„ , THE POLICIES OF INSURANCE LISTED BELOW HAVt tsttrv laaucv iv rn~ u~wr~w r......~...-.~-.--- • -•- ~••- - ---- WHICH THIS CERTIFICATE MAY BE ISSUED OR ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO IBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH THE INSURANCE AFFORDED BY THE POLICIES DESCR MAY PERTAIN , POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADD'L POLICY EFFECTIVE POLICY EXPIRATION LTR INSRD TYPE OF INSURANCE POLICY NUMBER DATE (MM/DD/YY) DATE (MM/DD/YY) LIMITS EACH OCCURRENCE $ KXKXX_XX GENERAL LIABILITY DAMAGE TO RENTED $ XXXXXXX COMMERCIAL GENERAL LIABILITY PREMISES Ea occurence MED EXP (Any one person) $ XXX~iCXX CLAIMS MADE ~ OCCUR NOT APPLICABLE XXXXXXX PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ XXXXXXX PRODUCTS -COMP/OP AGG $ XXXXXXX GEN'L AGGREGATE LIMIT APPLIES PER: PRO- POLICY JECT LOC AUT OMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ XXXXXXX ANY AUTO ALL OWNED AUTOS BODILY INJURY (Per person) $ XXXXXXX ABLE SCHEDULED AUTOS NOT APPLIC HIRED AUTOS BODILY INJURY (Per accident) $ XXXXXXX NON-OWNED AUTOS PROPERTY DAMAGE Per accident) $ XXXXXXX I ( AUTO ONLY - EA ACCIDENT $ XXXXXXX GA RAGE LIABILITY NOT APPLICABLE OTHER THAN EA ACC $ XXXXXXX ANY AUTO AUTO ONLY: AGG $ XXXXXXX EACH OCCURRENCE $ XXXXXXX EXCESSIUMBRELl11 LIABILITY XXXXXXX AGGREGATE $ I iJCCUR ^ CLAIMS MADE NO"f APPLICABLE $ XXXXXXX ^ UMBRELLA FORM $ XXXXXXX DEDUCTIBLE . . $ XXXXXXX RETENTION $ -,__ ----._.. _.._._.-----,..--- - _---_-. ----._--_- -----~--- WC STATU- OTH- A WC1929178(AOS) 4/1/2008 4/1/2009 X TORY LIMITS ER !1 WORKERS COMPENSATION AND EMPLOYERS' LIABILITY WC1929179 (CAj 4/1/2008 4/1/2009 E.L. EACH ACCIDENT $ 1,~~~,QO~ [~ ANV PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? WC1929181 (FL) 4/1/2008 4/1/2009 E.L. DISEASE - EA EMPLOYEE $ 1 000 000 > > , It yes,descdbeunder NO WC1929182(OR) 4/1/2008 4/1/2009 DISEASE-POLICY LIMIT E L $ 1,000,~~O A SPECIAL PROVISIONS below . . A OTHER WC1929184 (OH WA,WI,WV,WY 4/1/2008 4/1/2009 Statutory Limits -See Above A Worker's Compensation WC1929183 fXj~ WC1929180 MA 4/1/2008 4/1/2008 4/1/2009 4/1/2009 B DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Re: West Station Facilities Upgrade ~~~i, ~ 3500368 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION Clty of Santa Ana DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 3o DAYS WRITTEN Pu lic Works Agencyy NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL Attn: Steve Worcall, P.E Sr. Civil Engineer 220 S. Daisy Avenue, M85 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR P.O. Box 1988 REPRESENTATIVES. - Santa Ana CA 92702 AUTHORIZED REPRES ...........~ .....,.. ,,..,. __ _____,___ ____~:__ ..:_ __..:~__._ _,....~...,.e ....mb, na.n ~.. rbe •Produeef section above ands city the cli cod Aecreor. ©ACORD CORPORATION 1988 .,...,r.~ ~., t ............. ~ - ,