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1 ® <br />^CO'?° CERTIFICATE OF LIABILITY INSURANCE DAT E(MM/DDNYYY) <br />D4/t62D„ <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: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) 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 />certificate holder in lieu of such endorsement(s). <br />PRODUCER <br /> <br />i <br />k <br />i <br />h CONTACT <br />NAME: <br />Aon R <br />Se rv <br />s <br />CeS Nort <br />east, Inc. O <br />FAX <br /> <br />Providence RI Offi CP_ (866) 283-]122 <br />(84]j 953-5390 <br />(A/C. No. Exq: q/C. No. <br />100 Westml n5ter Street, 10Th FI OOr E-MAIL <br />Providence Ri 02903-2393 u5A ADDRESS: <br /> INSURER(S) AFFORDING COVERAGE NAIC p <br />INSURED INSURER A: Li be rLy MULUaI Fl re Zns CO 23035 <br />Gilbane Building Company <br />INSURER B: Liberty Insurance CorporaLi on <br />42404 <br />Seven ]aCksOn Walkway <br />PrOVl denCe RI 029400000 USA INSURER C <br /> INSURER D: <br /> INSURER E: <br /> INSURER F: <br />COVERAGES CERTIFICATE NUMBER: 57004220'1687 REVISION NUMBER: <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. Limits shown are as requested <br />LTR TYPE OF INSURANCE INSR 1M/D POLICY NUMBER MMIDD/WW LIMIT S <br />A GENERAL LIABILITY TB Tt <br />L? EACH OGCURRE NGE $2 , OOO , OOO <br /> X COMMERCIAL GENERAL LIABILITY OV <br />gpPR - - <br />?- <br />PREMISES Ea occurrence $1 , 000 , 000 <br /> CLAIMS-MADE ? OCCUR '? L .. <br />' MEp EXP (Any one person) $lO, 000 <br /> / <br />E STp CK PERSONALBADV INJURY $2,000,000 <br /> A <br />?`? <br />it forney GENERAL AGGREGATE $4,000,000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER: t C <br />y <br />?51St21rl l ?/ ?I PROpUCTS -COMP/OP AGG $4 , 000, 000 <br /> POLICY X PRO- X LOC <br />A AUTOMOBILE LIABILITY AS - 11- O - COMBINED SINGLE LIMIT <br />$1 <br />000 <br />000 <br /> Ea accitleni , <br />, <br /> X ANY AUTO BODILY INJURY (Per person) <br /> ALL OWNED <br />AUTOS SCH EOULEO <br />AUTOS BODILY INJURY (Per accident) <br /> <br />HIRED AUTOS <br />NON-OWNEp PROPERTY pAMAGE <br /> AUTOS Par accitlanl <br /> <br />A X UMBRELLA LIAB % OCCUR TL2 6112 5 90680$O 06/30/2010 06/30/2011 EACH OCCURRENCE $10,000,000 <br /> E%CESS LIAB CLAIMS-MADE AGGREGATE $10,000,000 <br /> DED RETENTION <br />B WORKERS COMPENSATION AND WA761D259O68030 06 30 2010 06 30 2011 X WC STATU- OTH- <br /> EMPLOYERS' LIABILITY <br />. TORY LIMITS ER <br /> ` <br />/ N <br />ANY PROPRIETOR/PARTNER /EXEC VTIVE ? <br />N <br />OFFI <br />ER/MEM <br />ER EX <br />D <br />N / A E.L. EACH ACCIDENT $1, OOO, OOO <br /> C <br />B <br />CLU <br />ED <br />(Mantlalory in NHI <br />It <br />tl <br />nb <br />tl E.L. DISEASE-EA EMPLOYEE $l, 000, 000 <br /> yes <br />esc <br />e un <br />er <br />DESCRIPTION OF OPERATIONS below <br />E.L. DISEASE-POLICY LIMIT <br />$l, 000, 000 <br /> <br />DESCRIPTION OF OPERATIONS (LOCATIONS /VEHICLES (Attach ACORD 101, Atlditional Remarks Schetlule, i1 more apace is requiretl) <br />Pro? ect: Garfield Elementary School - Block Grant Requirements. The City of Santa Ana, its officers, agents, volunteers, and <br />employees are addiLi onal insured as required by contract for this project only. <br />CERTIFICATE HOLDER <br />CAN C E LLATI O N <br /> 3HOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE <br /> EXPIRATION DATE THEREOF, NOTICE HALL BE DELIVERED IN ACCORDANCE WITH THE <br /> POLICY PROVISIONS. <br />City Of Santa And AUTHORIZED REPRESENTATIVE <br />20 Civic Center Plaza, M-25 <br />Attn: Attn: Interim Exec. <br />Po Box 1988 Di rector ? ? ?? <br />Santa Ana, CA 92702 USA iLE4ifGtGtO >iQ <br /> ©1988-20'10 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2070/05) The ACORD name and logo are registered marks of ACORD <br />u`> <br />c <br />m <br />a <br />'o <br />O <br />2 <br />0 <br />N <br />O <br />r- <br />Z <br />N <br />u <br />N <br />U