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coRO CERTIFICATE OF LIABILITY INSURANCE I DATE eWDON )
<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: ti the eertiflcate holder Is an ADDITIONAL INSURED, the policy(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 endorsement(s).
<br />PRODUCER 1 -866- 220 -4625 CONTACT
<br />NAME:
<br />Holmes Murphy and Associates - Omaha PHONE FAX
<br />2637 South 158th Plaza ESA L
<br />ADDRESS:
<br />Suite 200 PRODUCER —
<br />Omaha, HE 68130 CUSTOMER ID II: _
<br />INSURERS) AFFORDING COVERAGE
<br />INSURED INSURERA: ZURICH AMERICAN INSURANCE COMPANY 16535 _
<br />Post, Buckley, Schuh & Jernigan, Inc. INSURERB: AMERICAN GUARANTEE & LIABILITY INSURANC 26247
<br />d /b /a PBS &J
<br />2001 NW 107th Avenue INSURERC: STEADFAST INSURANCE COMPANY 26387
<br />Miami, FL 33172 -2507 INSURER.:
<br />Cr1VFRAr:FC CCDTIG'Ir ATC All 1SaDCD. 17557n7n sr nerr uuur.r
<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 />INSR
<br />LTR
<br />TYPE OF INSURANCE
<br />�� SUaR POLICY EFF POLICY EXP
<br />POLICY NUMBER UWDD D
<br />LIMITS
<br />A
<br />GENERAL LIABILITY
<br />GLO 9139458 -04
<br />09/30/1
<br />09/30/11
<br />EACH OCCURRENCE _
<br />S 1, 000, 000
<br />X COMMERCIAL GENERAL LIABILITY
<br />DRrN —D
<br />PREMISES (Ea occurrence
<br />S 1,000,000
<br />CLAIMS � OCCUR
<br />-MADE LJ
<br />MED EXP Arty omperson)
<br />S 25,000
<br />'X Contractual Liability
<br />PERSONAL EADV INJURY
<br />$ 1,000,000
<br />GENERAL AGGREGATE
<br />S 2,000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />PRODUCTS - COMPIOP AGG
<br />S 2,000,000
<br />1 POLICY rx 1 PRO- X LOC
<br />S
<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 />APPRnVEp
<br />S TO
<br />F FORM
<br />Eaaadent)
<br />S 2,000,000
<br />BODILY INJURY (Per person)
<br />_
<br />$
<br />ALL OWNED AUTOS
<br />-_�
<br />SCHEDULED AUTOS
<br />7.
<br />7
<br />`
<br />BODILY INJURY (Per accident)
<br />S
<br />PROPERTY DAMAGE
<br />(Per accident)
<br />$
<br />X HIRED AUTOS
<br />G
<br />X NON -OWNED AUTOS
<br />Li:uf Q �
<br />a Sheed
<br />S
<br />X Contractual Liability
<br />ASD1
<br />S
<br />C
<br />X 11MBRELLALIAB X OCCUR
<br />AUC 508762106
<br />09/30/1
<br />9/30/11
<br />EACH OCCURRENCE If25,000,000
<br />EXCESS LIAR CLAIMS -MADE
<br />- - -- --
<br />AGGREGATE
<br />2 5, 000, 000
<br />DEDUCTIBLE
<br />X RETENTION S 0
<br />S
<br />A
<br />WORKERS COMPENSATION
<br />LIABILITY
<br />WC 9139459 -04
<br />0 9 /3 0 / 1
<br />09/30/11
<br />AT
<br />X WCSTATU- OT"-
<br />Als1 'PROPRIETORIPARTNERIE)(ECUTIVE
<br />OFFICERIMEMBER EXCLUDED? N
<br />N/A
<br />Il
<br />5 i, 000, 000
<br />e.L. EACH ACCroENi_
<br />(Mandatory In NH)
<br />If es,derTIONGF60'
<br />I_
<br />E.L. DISEASE- EAEMPLOYE
<br />$ 1,000,000
<br />E.L. DISEASE - POLICY LiM1T
<br />$ 1,000,000
<br />DESCRIPTION OF OPERATIONS below
<br />DESCRIPr10N OF OPERATIONS LOCATIONS /VEHICLES (Attach ACDRD 701, Additional Remarks SeMdub, Nmore k
<br />apsee requked)
<br />RE: Combined Project Study Report /Project Report (PSR /PR), Environmental Document, (ED), and PS &E preparation for the
<br />SR -55 /14acArthur 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 />Santa Ana, City of
<br />Public Works Agency M -36
<br />20 Civic Center Plaza, 4th Floor
<br />Santa Ana, CA 92701
<br />USA
<br />edornne
<br />Acnon'Ja r�nna/nm
<br />r says ume
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />AUTHORIZED REPRESENTATIVE
<br />— 491�'Vdlze
<br />m 1988 -2009 ACORD CORPORATION. Ail rlahts
<br />17557070 ' ""' ^"" "" " ° "1Q — n,yv me rv(lrelerW manly OT A9,UKLP
<br />
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