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k!FF& CERTIFICATE OF LIABILITY INSURANCE ° "� .JJ .ID
<br />09/2 B /2010
<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: M the certificate holder is an ADDITIONAL INSURED, the polky(les) must be endorsed. If 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 />certlf sate holder in lieu of such endorsement(s).
<br />PRODUCER 1 -866- 220 -4625
<br />CONTACT
<br />NAME:
<br />Holmes Murphy and Associates - Omaha
<br />PHONE FAX
<br />AIC Na Ens
<br />2637 South 158th Plaza
<br />E41AIL
<br />ADDRESS:
<br />Suite 200
<br />PRODUCER.- - _ __
<br />Omaha, NH 68130
<br />CUSTOMER ID t:
<br />INSURER(8) AFFORDING COVERAGE NAIC e
<br />_ _
<br />INSURERA: ZURICH AMERICAN INSURANCE COMPANY 16535_
<br />INSURED
<br />Poet, Buckley, Schuh 4 Jernigan, Inc.
<br />d /b /a PHSfiJ
<br />: INSURERS AMERICAN GUARANTEE 4 LIABILITY INSURANCI 26247
<br />INSURERC: STEADFAST INSURANCE COMPANY 26387
<br />2001 NW 107th Avenue
<br />- - -___
<br />INSURER D,___
<br />Miami, FL 33172 -2507
<br />_--
<br />INSURER E:
<br />INSURER F:
<br />PERSONAL aADV INJURY
<br />CERTIFICATE NUMBER: 17557070
<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 />IN8R TYPE OF INSURANCE �NSR BURR POLICY NUMBER
<br />r POLICY EFF POLICYEXYY LIMITS
<br />A GENERAL LIABILITY
<br />GLO 9139458 -04
<br />09/30/1 09/30/11
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />X COMMERCIAL GENERAL LIABILITY
<br />DAMAGE N
<br />PREMISES (Ea oec )
<br />E 1,000,000
<br />�_
<br />CLAIMS -MADE OCCUR
<br />MED EXP M o
<br />( ^ °I
<br />$ 25,000
<br />X Contractual Liability
<br />— _
<br />PERSONAL aADV INJURY
<br />E 1_000,000
<br />GENERAL AGGREGATE
<br />S 2,000,000
<br />_
<br />_
<br />PRODUCTS- COMP/OP AGG
<br />E 00
<br />GENL AGGREGATE LI MIT APPLIES PER
<br />POLICY X PRO- X LOC
<br />JECT
<br />_,_000,
<br />S
<br />B ` AUTOMOBILE LIABILITY
<br />BAP 9139457 -04
<br />09/30/10 09/30/11
<br />COMBINED SINGLE LIMIT
<br />(Ea arcideM)
<br />52,000,000
<br />X ANY AUTO
<br />ALL OWNED AUTOS ''
<br />� APPROVED
<br />AS
<br />TO FORM
<br />BODILY INJURY (Per person) I E
<br />'
<br />_—
<br />SCHEDULED AUTOS
<br />-
<br />BODILY INJURY (Per a¢ident) I E
<br />--
<br />PROPER TY DAMAGE
<br />X HIRED AUTOS
<br />_
<br />(Peremident) S
<br />X NON- OWNEDAUTOS
<br />E
<br />LBUTU
<br />)tt .heedy
<br />X Contractual Liability5
<br />C j UMBRELLA LIAR I X I OCCUR
<br />ADC 508762106
<br />09/30/10 09/30/11
<br />EACH OCCURRENCE E 25,000,000
<br />EXCESSLNB
<br />_ CWMS - MADE:.
<br />- - - - - - -
<br />i,
<br />RE -..
<br />AGGREGATE E 25,000,0°0
<br />--
<br />DEDUCTIBLE
<br />S
<br />X RETENTION S 0
<br />— — - - - -_-
<br />S
<br />A AND EMPL COMPENSATION
<br />ANDEMPLOYERS'LWILR1'
<br />WC 9139459 -04
<br />09/30/10 09/30/11
<br />X WCSTATU- OTH-
<br />YIN
<br />ANYMOPWETORWARTNEWEXECUTIVE
<br />OFFICERIMEMBER EXCLUDED?
<br />NIA
<br />51,000,000
<br />E.L. EACH ACCIDENT
<br />. .... .. ......_..—
<br />_
<br />$ 1, 000, 000
<br />(MaMe(Ory in NHI
<br />0 yes, describe oMer
<br />E.L. DISEASE - EAEMPLOYE
<br />E.L. DISEASE - POLICY LIMIT
<br />f 1, 000, 0 00
<br />DESCRIPTION aF OPERATIONS Oabw
<br />DESCRIPTION OF OPERATIONS/ LOCATIONS I VEHICLES (Aaaah ACORD 101, AddaI— Ram Mb dWa, N-1 aP.- b r.gak-A
<br />RS: Combined Project Study Report /Project Report (PSR /PR),
<br />Environmental Document, (ED), and PSiE preparation for the
<br />SR -55 /MacArthur Blvd. Interchange Ramp widening Project, Project
<br />Number r 07 -2503. The City of Santa Ana, its officers,
<br />agent., representatives, volunteers and employees are Additional
<br />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 />CERTIFICATE HOLDER
<br />CANCELLATION 90 days GL, AUTO , WC / 60 days UME
<br />Santa Ana, City of
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />Public work. 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 />Sent. Ana, CA 92701
<br />USA
<br />G41;1 ��
<br />ACORD 0 (2009 109) The ACORD name and logo are registered marks of ACORD u CORPORATION. All rights reserved.
<br />17557070
<br />
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