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coRrl CERTIFICATE OF LIABILITY INSURANCE I A eWDON I
<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: H the certificate holder is an ADDITIONAL INSURED, the pollcy(les) must be endorsed. H SUBROGATION IS WAIVED, subject to
<br />the terms 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 endomeme s .
<br />PRODUCER 1- 866 - 220 -4625 CONTACT
<br />NAME:
<br />Holmes Murphy and Associates - Omaha PHONE F
<br />2637 South 158th Plaza EMAIL
<br />ADDRESS:
<br />Suite 200 PRODUCER - - - -- -
<br />Omaha, NE 68130 CUSTOMERIDt:
<br />INSURER(SIAFFORDINGCOVERAGE __ NAIC�
<br />INSURED INSURERA: ZURICH AMERICAN INSURANCE COMPANY 16535
<br />Poet, Buckley, Schuh 6 Jernigan, Inc.
<br />d /b /a PBSfiJ INSURERS: AMERICAN GUARANTEE 6 LIABILITY INSURANCIP26247
<br />2001 KWPL033172Venue ) NSURERC: STEADFAST INSURANCR COMPANY - —_ 26387
<br />INSURER D:
<br />rnVFRAr.FS rFRTIFIrATC IUII CD• 1755707n no%mm1 wumrs.
<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 />INS R
<br />LTR
<br />TYPE OF INSURANCE
<br />ADDL SUBR POLICY EFF POLICY EXP
<br />POLICY NUMBER MMfDD D
<br />LIMITS
<br />A
<br />GENERAL LIABILITY
<br />GLO 9139458 -04
<br />09/30/1
<br />09/30/11
<br />EACH OCCURRENCE _
<br />DAAA�GE
<br />E 1,000,000
<br />X COMMERCIAL GENERAL LIABILITY
<br />TO RENTED
<br />PREMISES (Ea occunence
<br />E 1,000,000
<br />CLAIMS MADE OCCUR
<br />_-��
<br />MED EXP (Airy one person)
<br />S 25,000
<br />X Contractual Liability
<br />- --
<br />PERSONAL BADV INJURY
<br />$ 1,000,000
<br />-_ -
<br />_ —_
<br />GENERAL AGGREGATE
<br />PRODUCTS - COMPIOP AGO
<br />S 2,000,000
<br />S 2,000,000
<br />GEN'LAGGREGATE LIMITAPPLIES PER:
<br />POLICY X PRO- 7 X LOC
<br />b
<br />B
<br />AUTOMOBILE LIABILITY
<br />BAP 9139457 -04
<br />09/30/1
<br />09/30/11
<br />COMBINED SINGLE LIMIT
<br />X ANY AUTO
<br />APPROVED
<br />S TO
<br />FURM
<br />S 2,000,000
<br />BODILY INJURY - --
<br />BODILY NJURY (Per person)
<br />-
<br />E
<br />ALL OWNED AUTOS
<br />SCHEDULED
<br />BODILY INJURY (Per etoident)
<br />E
<br />AUTOS
<br />-!
<br />PROPERTY DAMAGE
<br />X HIRED AUTOS
<br />(Peraccldenl)
<br />E
<br />X NON -OWNED AUTOS
<br />Liu iv Vj
<br />Ll
<br />X Contractual LiabilityA5S15
<br />'
<br />S
<br />CII
<br />X INABRELLALIAB X LOCCUR
<br />09/30/1
<br />9/30/11
<br />EACH OCCURRENCE
<br />S 25,000,000
<br />DEXCESS LIAR LAIMS -MADEI
<br />AGGREGATE_
<br />E25, 000, 000
<br />___
<br />E
<br />EDUCTIBLE
<br />X � RETENTION S 0 7
<br />$
<br />A
<br />ANDEMPLOYERVLIABILIY
<br />WC 9139459 -04
<br />09/30/1
<br />09/30/11
<br />X WCSIIMIT OTH-
<br />YEN
<br />ANYPROPRIETOR /PARTNER/EXECLMVE
<br />OFFICEMMEMBER EXCLUDED? O
<br />NIA
<br />E 1,000.000
<br />E.L. EACHACCIDENT _
<br />E.L. DISEASE - EA EMPLOYEE
<br />$ 1,000,000
<br />(Mandatory In NH)
<br />I! describe urrder
<br />E.L. DISEASE -POLICY LIMIT
<br />S 1,000,000
<br />DESCRIPTION OF OPERATIONS bebw
<br />DESCRIPTION OF OPERA TDNS/ LOCATIONS /VEHICLES (Attach ACORD 101, Addklorul Remelts Sehadula, B mow k
<br />spas» raqukad)
<br />RE: Combined Project Study Report /Project Report (PSR /PR), Environmental Document, (ED), and PS&E preparation for the
<br />SR -55 /MacArthur Blvd. Interchange Ramp Widening Project, Project Number : 07 -2503. The City of Santa Ana, its officers,
<br />agents, representatives, volunteers and employees are Additional Insureds on the General Liability including Completed
<br />Operations, if required by contract,with respect to the operations of the insured. Severability of interest is included
<br />on the General Liability.
<br />- - -- � / e UWn
<br />Santa Ana, City of SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />Public works Agency M -36 ACCORDANCE WITH THE POLICY PROVISIONS.
<br />20 Civic Center Plaza, 4th Floor
<br />AUTHORIZED REPRESENTATIVE
<br />Santa Ana, CA 92701
<br />USA
<br />edornne 01988 -2009 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2009/09) The ACORD name and loco are realstered marks of ACORn
<br />
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