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f <br />_ �. <br />�/� R,O ®. - <br />`lfVo� CERTIFICATE OF LIABILITY INSURANCE" <br />D,,E iMIN/DD/YYyYJ <br />��lye:2oi� <br />Tpl$ CERTIFICi4TE IS ISSUED AS A MATTER OF INFORHU►TION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFCATE HOLDER. THIS <br />.. CERTIFICATE DOES. NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY YHE POWCIES <br />�` <br />BELOW. THIS CERTIFICATE OF IfJSU RANCE'DOES NOT CONSTITUTE A CONTRACT BETWEEN. THE ISSUING IN$URER(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. Jf SUBROGATION IS. WAIVED, subject to <br />the terms and conditions of the policy, certain pollclee may require aK endorsement A statement. on th is certificate does not confer rights to the <br />certificate - holder in Ileu of such endorsenlenf(s). <br />PRODUCER <br />Pearl IrtSYfinCC <br />9200 E -_ Glan Avanuo <br />P ®oris Flalghts+ IL 61616 <br />NAM :' Mike nnCCOy <br />PHONE 866 - 679 -0$02 FAJ( <br />- - c _� : 86fr559 -309.7 <br />-MAIL s Mike.MCCo Peadlnsuranoe_com - <br />INSURE S AFFORDING COVERAGE <br />NAK: p ' <br />- <br />INSURFJ3 A - Ve110y Forge 1RSYr'AACa cOLnpa..y- <br />07/01/72 <br />- <br />EACH OCCURRENCE <br />E 1 sODO,000 <br />- <br />INSURER B : Continanfal CaSYelty Com an <br />20443 <br />Albort GroTrer S Associates,_ Mc' <br />29 � Imperial Hwy, Suite 208 � <br />Fu11 ®rlon, CA 92835.90+17 - <br />INSUre =R c'i Am @rican Gs_ Co. of Raadin PA - <br />20427 <br />� '" - -- - - <br />INSURER ar <br />- - - - <br />INSURER E : � ' <br />PERSONAL- 6.f.DV INJURY <br />INSURER F <br />-NAMED ABOVE FOjt THE POLICY PERIOD <br />NTERM <br />NHDICATED,;CMOTIMTHS AN DING ANYIREq UIREIv1EM ORDCONDITIOPj OF ANY ONUTRPCTO OR OTHER DQGUMENT WITH RESPECT TO. WHICH THIS <br />CERTIFICATE MAY BE ISSUED' OR MAY•PERTA�N. THE INSURANCE AFFORDED BY THE AOLICIES DESpR[BEp HEREIM ]S SU BJEGT TO ALL,THE TERMS; <br />EXCLUSIONS P:NDCONO7TION5 OF SUCH POLIO fES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID G_LAIMS:- " <br />_� <br />�LTR <br />.TYPE OF INS VftAMDE <br />ADO <br />POLICY NUMBER <br />POLICY EFF <br />M O <br />POLICY EXP <br />MWD <br />- <br />LIMITS <br />A <br />GENERAL LIABILITY � _ <br />X COMMERCIAL GENERAL Lu:L11LnV <br />CLAIMS MADE �' OCCUR' <br />X <br />' � ' <br />7C <br />.4030800732 <br />07!07!'1'1 <br />07/01/72 <br />- <br />EACH OCCURRENCE <br />E 1 sODO,000 <br />- <br />FR AI E �' oraeron" � <br />. <br />E 9 s000r000 <br />MED EXP (A one vels«I <br />E 9Oa000 <br />X P111na /Nlon Contribute <br />.� rY <br />PERSONAL- 6.f.DV INJURY <br />E 9a000 +000' <br />GENERAL AGGREGATE � <br />E 2a000rOOO <br />GEN'L AGGREGATE <br />L {MIT APPLIES RER: <br />PRODUCTS- COMP/OP-AGG <br />E. Z +DO0�000 <br />X POLICY <br />PRO -. LOC <br />� <br />_. <br />�C <br />3 <br />A <br />AUTONIOa1LE <br />X <br />LIABILITY � - <br />AIyY'ALfTO. <br />ALLOWNEb SCHEDULEq <br />AUTOS AUTOS <br />HIFRED AUTOS X_ UTQS ED <br />_ <br />- <br />4030800732 <br />Indudad 1n GL policy <br />Hlrei(Auto P}I sical Da ma e <br />Uaductlble: S SO 9. <br />.. <br />07/01/71 <br />07/09/12 <br />HMS SIN LMIT <br />w -- ' <br />:10.00,000 <br />BODILY INJURI`(Parpennn_) <br />E <br />BODILY INJURY (Per eoCtlent) <br />E <br />PR aE�Ra DAMAGE <br />E ' <br />E" <br />B <br />X <br />vuleRELLq LWe, <br />X. <br />OCR <br />4030809783- <br />OTJO'1. /91 <br />OT /O9 /9Z <br />eAGH OCCURRENCE <br />S2 rOOO,O00' <br />'AGGREGATE <br />S.2 +000000 <br />E%CESS LIAB <br />CLAIMS -TE e..DE <br />EXGIYdCS ProiesSlOna1 <br />Liab1111y <br />DEO r1ETENTIONE <br />___ <br />S <br />C <br />WORKERS, COMPENSATION ` <br />AND EMPLOYERS' UAHO_ITY <br />ANY PROPRIETDR/PARTNER)E%ECUTIVE Y / N <br />OFFICER/MEMBER EXCLUDErYJ � <br />(Mandalgry In NRI) <br />If yyes, tleaetlbe antler <br />DESCRIPTION'OF.OPERATIONS belouv <br />N / A <br />X <br />430800780' <br />Blanket Waiver of Subro afiori <br />9 <br />Endt WC�D.i1� <br />OT/09/91 <br />OT /07/12 <br />�( WC STAT U- OT H- <br />E.L. EACH ACCIDENT <br />. ' <br />5 1. OOO OOO <br />E.L DISEASE -- EA EMPLOYE <br />9 +000 <br />i +000 <br />- - _.. <br />E. L. DISEASE- POLICY'LIMIT <br />E'l�OOO +000 <br />B <br />ProiassionalFLlability - <br />MCA2883S4455 <br />07/01/71 <br />07/09M.2. <br />52,000, 00 -aa ., claim - <br />cla;.r.g Made <br />APP- <br />Oi�ED <br />Sa'000,000 aggr®Sa #. <br />DESGRIPTON OF OPERATONS /LOCATIONS / VERICLES (Atlarh ACORD 10'1, Atltlltlonal Rarnarlcs Schedule,'N more.epe� 1s IegW ratl) <br />CivillTransportation/Traffic Engineering Finn -�� /�� /�� <br />Laura Stitt She�T- <br />RE: 20t0 Citywide Engineering and Traffic Survey y <br />Assistant City Attorney <br />Exdudad officer Albert Grover from the above Workers Compensavon Policy <br />City of Santa Ana <br />2D Civic Center Plaza, M-A3 <br />{ Santa Ana CA 9270'1 <br />ACORD 25 (2010/05) <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION' DATE , THEREOF, NOTICE WILL BE DELNERED IN <br />ACCORDANCE WITH THE POLICY PROV7310N5- <br />I AU'1"HOR¢ED REPRESENTATVE <br />/� <br />©1988 -201 O ACORD CORPORATION. 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