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ACORN TM CERTIFICATE OF LIABILITY INSURANCE
<br />Date(MM /DD /YR)
<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 BELOW,
<br />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 the terms
<br />and conditions of the policy, certain policies require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of
<br />such endorsement(s).
<br />PRODUCER
<br />Heffernan Insurance Brokers
<br />CONTACT Sherry Young
<br />NAME'
<br />PHONE
<br />A /QNo,Ext: 714. 361.7700
<br />I (FAX
<br />AIC,No): 714.361.7701
<br />License No. 0564249
<br />6 Hutton Centre Dr., Suite 500
<br />Santa Ana, CA 92707
<br />EMAIL sherryy@heffins.com
<br />ADDRESS:
<br />INSURERS AFFORDING COVERAGE
<br />NAIC #
<br />INSURED
<br />INSURER A:
<br />Travelers Property Casualty Co of Am.
<br />25674
<br />T & B Planning
<br />INSURER B:
<br />Travelers Indemnity Cc of Connecticut
<br />25682
<br />17542 E. 17" St., Suite 100
<br />INSURER C:
<br />Continental Casualty Co,
<br />20443
<br />INSURER D:
<br />Tustin, CA 92780
<br />INSURER E:
<br />INSURER F:
<br />COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
<br />THIS IS TO CERTIFY THAT POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED,
<br />NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT W ITH RESPECT TO W HICH THIS CERTIFICATE MAY BE
<br />ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF
<br />SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />INBR
<br />LTR
<br />TYPE OF INSURANCE
<br />ADOL
<br />INSR
<br />SUBIR
<br />WVD
<br />POLICY NUMBER
<br />POLICVEFF
<br />MMIDDIYYVY
<br />POLICY EXP
<br />MMIDDIVYYY
<br />LIMITS
<br />GENERAL L LIABILITY
<br />EACH OCCURRENCE
<br />$2,000,000
<br />A
<br />B
<br />X COMMERCIAL GENERAL LIABILITY
<br />�
<br />CLAIMS -MADE XI OCCUR
<br />x
<br />680708OP051TIL13
<br />680708OP536TCT13
<br />02/01/13
<br />02/01/13
<br />02/01/14
<br />02/01/14
<br />DAMAGE TO RENTED
<br />PREMISES (Ea occurrence)
<br />$1000,000
<br />MED EXP(Any one person)
<br />$10,000
<br />PERSONAL& ADV INJURY
<br />$2,000,000
<br />GENERAL AGGREGATE
<br />$4,000,000
<br />GEN'L. AGGREGATE LIMIT APPLIES PER
<br />PRODUCTS- COMPIOP AGO
<br />$4,000,000
<br />POLICY X PROJECT LOO
<br />$
<br />A
<br />AUTOMOBILE
<br />LABILTY
<br />68070SOP051TIL13
<br />02/01/13
<br />02101/14
<br />COMBINED SINGLE LIMIT
<br />Be accident)
<br />$monn cL
<br />BODILY INJURY (Per person)
<br />$
<br />B
<br />ANYAUTO
<br />680708OP536TCT13
<br />02/01/13
<br />02/01/14
<br />ALL OWNED AUTOS SCHEDULED
<br />AUTOS
<br />HIRED AUTOS X NON -OWNED
<br />AUTOS
<br />BODILY INJURY Per acciaccident)
<br />$
<br />X
<br />PROPERTY DAMAGE
<br />(Per awlldent)
<br />$
<br />5
<br />X
<br />UMBRELLA ILIAD
<br />X
<br />OCCUR
<br />CUP708OP6161347
<br />02/01/13
<br />02/01/14
<br />EACH OCCURRENCE
<br />$2,000,000
<br />A
<br />EXCESS LIAB
<br />CLFlI MS -MADE
<br />AGGREGATE
<br />$2,000,000
<br />DED X RETENTION s0
<br />$
<br />WORKERS COMPENSATION
<br />ANDEMPLOYERS'LIABILITY VIN
<br />X WC STAT0. OTH-
<br />TORY L MITS ER
<br />E,L. EACH ACCIDENT
<br />$1,000,000
<br />A
<br />ANYPROPRIETOR /PARTNER/EXECUTIVE/
<br />OFFICEWMEMBER EXCLUDED? �
<br />XJUB3393T34413
<br />02/01/13
<br />02/01/14
<br />E. L. DISEASE - EA EMPLOYEE
<br />$1,000,000
<br />(Mandatory In N.H.)
<br />If yes, describe under DESCRIPTION OF
<br />OPERATIONS below
<br />I
<br />E.L. DISEASE - POLICY LIMIT
<br />$1,000,000
<br />C
<br />Professional Liability
<br />MCH288294144
<br />09/20/12
<br />09/20/13
<br />r Claim
<br />Aggregate
<br />$1,000,000
<br />$2,000,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Xio ch ACORD 101, Additional Remarks Schedule, If more space Is required)
<br />Projects as on file with the insured including but not limited to Walnut Pump Station Building Upgrade, City of Santa Ana. City of Santa Ana, It's officers, employees, agents,
<br />volunteers and representatives are named as additional insured mid rimary /non - contributory clause applies as respects the general liability policy -see attached endorsement.
<br />CERTIFICATE HOLDER CANCELLATION
<br />SHOULD ANY OFTHE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
<br />CI Of Santa Aria
<br />Ty
<br />EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH
<br />THE POLICY PROVISIONS.
<br />Public Works Agency Corporate Yard
<br />M-85 220 S. Daisy Avenue
<br />AUTHORIZED REPRESENTATIVE
<br />Santa Ana, CA 92702
<br />/ff �
<br />ACORD 25 (201111 ©1- 8.2010 ACORD CORPORATION. All rights reserved.
<br />APPROVED A AS ' ' 6hhee ACCORD name and logo are registered marks of ACORD
<br />L�auu� ti Sheedy
<br />Assistant ity Attornewl
<br />
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