BLACK & VEATCH CORPORATION - 2011

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I r J Ac"R" CERTIFICATE OF LIABILITY INSURANCE 1� c _ 11/1/2013 DATE(MM /DD/YYYY) 1 10/26/2012 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Lockton Companies, LLC -1 Kansas City 444 W. 47th Street, Suite 900 Kansas City MO 64112 -1906 (816) 960 -9000 CONTACT PHONE FAX Arc No E-MAIL ADDRESS: GENERAL LIABILITY Y N INSURERS AFFORDING COVERAGE NAIC # INSURER A: Zurich American Insurance Company 16535 INSURED BLACK & VEATCH CORP INSURER B: INSURER C : 1058332 11401 LAMAR OVERLAND PARK KS 66211 INSURER D : Bui, Aim INSURER E: INSURER F: I�f�D1 a: IG[ C1� .7:fw \�I:AfI�JSM7:aa7[N� \:7JIf WJ:17:�Mi7RL: ►: -]dvI Ld fis" THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADD INSR SUBR WVD POLICY NUMBER POLICY EFF MM /DD/YYYY POLICY EXP MM /DD/YYYY LIMITS • GENERAL LIABILITY Y N GLO 4641358 11/1/2012 1 t/l/2013 EACH OCCURRENCE DAMAGE TO RENTED PREMISES (Ea occurrence) $ 300 000 X MMERCIAL GENE BILITY MED EXP (Any one person) $ 10,600 CLAIMS -MADE OCCUR X CONTRACTUAL PERSONAL 8 ADV INJURY $ 1,000,000 X BFPD & C/O & XCU GENERAL AGGREGATE $ 1000.000 PRODUCTS - COMP /OP AGG $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER POLICY PRO LOC JECT $ • AUTOMOBILE LIABILITY N N BAP 4641355 (AOS) 11/1/2012 111/1/2013 (Ea accident) $ 1,000,000 BODILY INJURY (Per person) $ XXXXXXX ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS Ix BODILY INJURY Per accident $XXXXXXX PROPERTY DAMAGE Per $ XXXXXXX NON-OWNED HIRED AUTOS X $XXXXXXX UMBRELLA LIAB OCCUR NOT APPLICABLE EACH OCCURRENCE $ XXXXXXX EXCESS LIAB CLAIMS -MADE AGGREGATE $ XXXXXXX DED I I RETENTION $ $ X • WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR /PARTNER /EXECUTIVE Y / N OFFICERIMEMBER EXCLUDED? FN NIA N WC 4641353 AOS) WC 4641354 �WI & MA) 11/1/2012 11/1/2012 11/1/2013 11/1/2013 X STAT TORY LIMIT ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1 000 000 Mandatory in NH) I (f yes, describe under E.L. DISEASE - POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) PN. 175203; Sanitary Sewer and Water Financial Plan RFP. The City, its officers, employees, agents, volunteers and representatives are included as additional insured on General Liability as required by written contract. APPROVED Ati TO FORM % CERTIFICATE HOLDER ---.a '3"" ,yneeay CANCELLATION See Attachments i Y Attor ey SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 11363208 AUTHORIZED REPRESENTATIVE City of Santa Ana 220 S. Daisy Avenue, M -85 Santa Ana CA 92703 ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD (91988-2010 APOFID CORPORATION. All rights reserved