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/ I Q E Ttt G DATE (MMIOOIYYYY) 10/14/2014 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION' ONLY AND CONFERS NO RIGHT'S 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 Grayling Insurance Brokerage Mansell Road Su i t e 3 7 0 Alpharetta GA 30022 CONTACT ,Ter No °� ola. NAME: PHONE . (770) 552 -4225 F (866)5 50-4082 (Aic N91; E DMAIL3780 CDr ADRESS: ' err y. no olaC re lin g- INSURER AFFORDING COVERAGE NAIC tl INSURER ANational Union Fire Ins. Co. ___19445 GENERAL LIABILITY INSURED Psomas 555 S. Flower Street .....INSURER Suite 4.300 Los Angeles CA 90071 INSURER. B INSURER C ; D: $ 1400,000 INSURER E: X 'COMMERCIAL, GENERAL LIABILITY INSURER F: rnVPPAnPQ CERTIFICATE NUMBER -14 -15 REVISION NUMBER: OF INSURANCE THIS IS TO CERTIFY THAT THE POLICIES ` v OE 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, INSIR LTR TYPE OF INSURANCE ADDL UBR' POLICY NUMBER POLICY EFF MM /DDNYYY POLICY EXP MMfDDlYY'YY LIMITS GENERAL LIABILITY EACH OCCURRENCE. $ 1400,000 X 'COMMERCIAL, GENERAL LIABILITY DAMAGE TO RENTED PREMISES rEa occurrence $ 500, 000 MEDEX'P(Any one person) $ 25,000 A CLAIMS -MADE 2047634 10%15/2014 4 /1/2015 PERSONAL & ADV INJURY $ 11000,000 ..00CUR X Contractual Liability GENERAL.. AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES 'PER: PRODUCTS, COMP /OP AGG $ 2,000,000 $ POLICY .' PRO- X, LOC '... AUTOMOBILE LIABILITY Es accdentSINGLE LIM @T.... 1. 000_,_000 BODILY INJURY (Per person) $ A ANY AUTO ALLOWNED SCHEDULED 514893 10/15/2014 ./1/2015 BODIL IINJURY(Peraccident) AUTGS AUTOS X NON -OWNED HIRED AUTOS AUTOS Ix E TY DAMAGE Per PROPE $ $ UMBRELLALIA® OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB H CLAIMS -MADE DED I RETENTION $ A WORKERS COMPENSATION 026034794 (ADS) 10/15/2014 4/1/2015 X WO5TATU- 0TH- A ... AND EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNERIEXECUTIVE Y 1 N DEFICEtoryin ER EXCLUDED? (Mandatary in NH) NIA 026034793 (CA) 10/15/2014 /1/2015 E.L. EACH ACCIDENT $ 11000,000 EL.DISEASE - EAEMPLOYE $ 1,000,000 F L DISEASE - POLICY LIMIT $ 11000,000 If yes, describe ender DE6GRIY a ION Ur OPERAI IONS helow DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional, Remarks Schedule, If more space is required) 2SAN410110t Professional Engineering 'Design Services Bristol Street Water Main Replacement. City, its officers, employees, agents, volunteers and representatives are additional insured as respects to General and Auto Liability as required by written contract. Primary and Non- Contributing coverage, Waiver of Subrogation applies to GL as required by written contract. 'Waiver of Subrogation or Rights applies to Wormers' Compensation policy only as required by a written signed contract prior to any loss occurring. GERTIFICATI MULUEK 6rFiNk C:LL_MIIUIY SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN I I' ACCORDANCE WITH THE POLICY PROVISIONS. City of Santa Ana Rudy Rosas 220 S . Daisy Avenue AUTHORIZED REPRESENTATIVE M -85 Santa Ana, CA 92703,,,! David Collings/JERRY ACORD 25 (2010105) (9 1Ubt$-ZU'IV At UKU 4UCCr UIV+I IUI '4. MII IIUIRb IUbt:I YCU, IN S025 ni Thn ACf1Rr't nnma and Innn ara ranictnrae4 mnr4c of hl":dlRr)