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CERTIFICATE OF LIABILITY INSURANCE DATE(M09/28/2010 WDDflYW�
<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), AUTHORRED
<br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER
<br />IMPORTANT: ti the Certificate holder is an ADDITIONAL INSURED, the Pollcy(les) must be endorsed. H SUBROGATION IS WAIVED, subject to
<br />the terns and conditions of the policy, certain policies may require an endorsement. A statement on this Certificate does not confer rights to the
<br />certificate holder In lieu of such endoreeme s .
<br />PRODUCER 1 -866- 220 -4625
<br />Holmes Murphy and Associates - Omaha
<br />2637 South 158th Plaza
<br />CONTACT
<br />NAME:
<br />PHONE
<br />/11C No En : _, _ _ _jAfG• Nol:
<br />_ _
<br />EMAIL
<br />ADDRESS:
<br />Suite 200
<br />PRODUCER
<br />Omaha, HE 68130
<br />CUSTOMER ID t:
<br />IMSU"S) AFFORDING COVERAGE NAILS
<br />INSURERA: ZURICH AMERICAN INSURANCE COMPANY 16535
<br />INSURED
<br />Post, Buckley, Schuh 4 Jernigan, Inc.
<br />_
<br />INSURER B: AMERICAN GUARANTEE 5: LIABILITY INSURANC 26247
<br />_
<br />INSURER C: STEADFAST INSURANCE COMPANY26387
<br />2001 NW 107th Avenue
<br />INSURERD: - - --
<br />Miami, FL 33172 -2507
<br />---- �
<br />INSURER E: _
<br />—._._
<br />INSURER F:
<br />$25,000
<br />IPIUAICNUMMtN' I-1—
<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 RECIURiEMENT, 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 />--
<br />ILTR TYPE OF INSURANCE lUSR POLICY EFF POLICY EXP
<br />LTR POLICY NUMBER MM/DD NVODIYYYY LIMITS
<br />A I GENERAL LIABILITY
<br />GLO 9139458 -04
<br />09/30/10 09/30/11
<br />EACH OCCURRENCE
<br />E 1,000,000
<br />X COMMERCIAL GENERAL LIABIU ry
<br />Santa Ana, CA 92701
<br />USA
<br />N
<br />PREMISES (Ea occurrence)
<br />E 1, 000, 000
<br />Ir _ CLAIMS- MADE,OCCUR
<br />MED EXP(Arr one perm,)
<br />$25,000
<br />'.% Contractual Liability__
<br />PERSONALSADV INJURY
<br />51,000,000
<br />GENERAL AGGREGATE
<br />E 2,000,000
<br />PRODUCTS - COMP /OP AGG
<br />$2,000,000
<br />GENTAGGREGATE LIMIT APPLIES PER
<br />POLICY X PR6 X LOC
<br />S
<br />B AUTOMOBILE LIABILITY
<br />BAR 9139457 -04
<br />09/30/10 09/30/11
<br />COMBINED SINGLE LIMIT
<br />(Ee er<idenl)
<br />5 ?000,000
<br />X ANY AUTO
<br />BODILY INJURY (PerPene,)_. s _-
<br />ALL OWNED AUTOS
<br />APPROVED AS
<br />TO FORM
<br />SCHEDULED AUTOS .
<br />-
<br />BODILY INJURY (Per aackient) S
<br />- -
<br />X
<br />PROPERTY DAMAGE
<br />$
<br />HIRED AUTOS
<br />r—
<br />(Peremdeni)
<br />Laura ltt
<br />X NON -OWNED AUTOS
<br />'X Contractual Liability
<br />tcedy
<br />is
<br />C % J UMBRELLA LIAR I X I OCCUR
<br />AUC 508762106 09/30/10 09/30/11
<br />EACHOCCURRENCE 5 25,000,000
<br />EXCESS LMB CLAIMS -MADE
<br />�
<br />AGGREGATE E 25,000,000
<br />_ DEDUCTIBLE
<br />X RETENTION S 0
<br />S
<br />A WORKERS COMPENSATION
<br />AND EMPLOYERSLIABILITY
<br />NC 9139459 -04 09/30/10 09/30/11
<br />X WCSTATU- OTM-
<br />YIN
<br />ANYPROPRIET TCTLNUDE07 ECVTNE
<br />OFFX.ERaIEMBER EXCLUOE07
<br />N/A
<br />51,000,000
<br />E.L. EACH ACCIDENT
<br />_... _..
<br />(Mandebry m NH)
<br />O yes, Eemribe un4er
<br />E.L. DISEASE -EA EMPLOYEE
<br />51,000,000
<br />—
<br />E.L. DISEASE - POLICY LIMIT
<br />$ 1,000,000
<br />DESCRIPTIONOFOPERATIONSbebw
<br />DESCRIPTION OF OPERATIONS LOCATIONS I VEHICLES (Aeaeh ACORD 107, Addkiaul Ihmvlu SehMub, N mon �Wp b rpWred)
<br />RE: Combined Project Study Report /project Report (PSR /PR), Environmental Document, (ED), and PS&Z preparation for the
<br />SR -55 /MacArthur Blvd. Interchange Ramp Widening Project, Project Number t 07 -2503. The City of Santa Ana, its officers,
<br />agents, represeatativea, volunteers end employees are Additional Insureds on the General Liability including Completed
<br />Operation., if required by contract,with respect to the operations of the insured. Severability of Interest is included
<br />on the General Liability.
<br />ACORD 25 (2009109) The ACORD name and logo are registered marks of ACORD RD CORPORATION. All rights reserved.
<br />A
<br />17557070
<br />WC / 60 da S UMS
<br />Santa Ana, City of
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES DE CANCELLED BEFORE
<br />Public works Agency M -36
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />20 Civic Center Plaza, 4th Floor
<br />AUTHORIZED REPRESENTATIVE
<br />Santa Ana, CA 92701
<br />USA
<br />�
<br />�
<br />ACORD 25 (2009109) The ACORD name and logo are registered marks of ACORD RD CORPORATION. All rights reserved.
<br />A
<br />17557070
<br />
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