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AC6J7hP CERTIFICATE OF LIABILITY INSURANCE
<br />DATE IMMtoDrrvvvl
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
<br />9/3/2014
<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 CAR 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 Molder is an ADDITIONAL INSURED, the policy(tes) 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 8=dgewood Partners Insurance Center (EPIC)
<br />CONTACT
<br />NAME: Denl Dryer
<br />J
<br />19 100 MacArthur Blvd. PH' Floor
<br />PHONE � FAX
<br />949 -417 9129 (A1c No):
<br />Irvine, CA X2612
<br />>t �e�tl
<br />6609159L189
<br />ADDRESS Deni.Dryer@epicbrokers.com
<br />1123/2015
<br />INSURER (S) AFFORDING COVERAGE NAIL #
<br />INSURER A : Travelers Property Casualty Cc of America
<br />www.edgewoodins.com
<br />INSURED
<br />INSURER B: ACE American Ins Company
<br />Rai pros, Inc.
<br />1 Arrta Parkway, Suite 200
<br />$ 1,000,000
<br />Irvine CA 92618
<br />INSURER D:
<br />INSURER E
<br />INSURER F
<br />MED EXP (Any one person)
<br />$ 10,000
<br />COVERAGES CERTIFICATE NUMBER: 21455897 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.
<br />ILTR.
<br />LTR
<br />TYPE OF INSURANCE
<br />INSD
<br />WVD
<br />POLICY NUMBER
<br />MMYam1YYYY._....MM
<br />)DOYYY.
<br />LIMITS
<br />A
<br />✓
<br />COMMERCIAL GENERAL LIABILITY
<br />,„✓
<br />6609159L189
<br />1123/2014
<br />1123/2015
<br />EACH OCCURRENCE
<br />1,000,000
<br />._.m._..
<br />m..... .
<br />CLAIMS- MADE Jr OCCUR
<br />_.___......_.._..._.
<br />DAMAGE TO RENTED
<br />PREMISES E. ccurranee
<br />$ 1,000,000
<br />MED EXP (Any one person)
<br />$ 10,000
<br />PERSONAL 8.. ADV INJURY
<br />$ 1,000,000
<br />AGGREGATE LIMIT APPLIES PER:
<br />GFN`L
<br />GENERAL AGGREGATE
<br />$ 2,000,000
<br />PRO-
<br />POLICY ®
<br />POLICY 1:1 LOC
<br />PRODUCTS - COMWOP AGG
<br />$ 2,000,000
<br />$
<br />OTHER:
<br />J
<br />A
<br />AUTOMOBILE.
<br />LIABILITY
<br />BA913760069
<br />8/3012014
<br />1/23/2015
<br />COMBINED SINGLE LIMIT
<br />a accident
<br />$...
<br />1,000,000
<br />ANY AUTO
<br />Phys. Damage - $50,000
<br />BODILY INJURY (Per person)
<br />$..
<br />�.
<br />ALL OWNED . -_ -- SCHEDULED
<br />!Comp /Coll. - $500 DED
<br />- ..�"®'-'- m " " -.....
<br />BODILY INJURY (Per accident)
<br />$
<br />AUTOS AUTOS
<br />. -. ..
<br />MONO -OWNED
<br />PFOPERT"TbAMAGE
<br />$
<br />A
<br />✓
<br />HIRED AUTOS
<br />BA98760069
<br />8/30/2014
<br />112312015
<br />Per
<br />Hired & Non -Owned
<br />$
<br />A
<br />UMBRELLA LIAB ✓ OCCUR
<br />CUP007C389159
<br />1/23/2014
<br />1/2312015
<br />EACH OCCURRENCE
<br />Q() 000
<br />EXCESS LIAR CLAIMS -MADE
<br />AGGREGATE
<br />$ 9,000,000
<br />DED I V RETENTION$0
<br />___..$
<br />A
<br />woRKERS COMPENSATION
<br />XJUB3392T21814
<br />2/1/2014
<br />2/1/2015
<br />� H
<br />AND EMPLOYERS" LIABILITY YIN
<br />�r SER
<br />I
<br />ANY PROPR ETORIPARTNEPJEXECUTIVE
<br />a
<br />NIA..
<br />E.L. EACH ACCIDENT
<br />$ 1,000000
<br />E.L. DISEASE - EA EMPLOYE
<br />$ 1 ,000,000
<br />OFFICERIMEMBER EXCLUDED?
<br />(Mandatory in NH)
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />.-- _...m_
<br />E.L. DISEASE - POLICY LIMIT
<br />.,,_..._.._ ............._.......-
<br />$ 1 ,000,000
<br />B
<br />Professional Liability
<br />625660560001
<br />2126/2014
<br />1 2/26/2015
<br />$5,000,400 Each Claim
<br />Claims Made Form
<br />$5,000,000 Aggregate
<br />Retro Date: 2/2612001
<br />$25,000 Deductible
<br />DESCRIPTION OF OPERATIONS 1 LOCATIONS i VEHICLES IACORD 101, Additional Remarks Schedule, may be attached If more space is required)
<br />`*"See Addendum For Complete List of Additional Insureds — RE: Santa Ana (quiet Zane Traffic Contract 4 30 14
<br />Coverage for work within 50 feet of railroad per policy form CG D379 0907 on GL and CA 2070 1001 on Auto. WC coverage applies for all states except
<br />monopolistic states. WC Waiver of Subrogation applies per WC 00 03 13. Certificate holder is additional insured on GL per attached form CG D3 81 0907
<br />which includes primary wording and waiver of subrogation and Auto per farm CA T3 53 03 10 but only if required by written contract with the named
<br />insured prior to an occurrence subject to all policy terms and conditions. All policies include a minimum of 30 day NOC with 10 day for non - payment.
<br />CERTIFICATE HOLDER CANCELLATION
<br />City Of Santa Arta
<br />y
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />Santa Ana Public Works Agency
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />Attn: Monica Suter
<br />20 Civic Center Plaza M -36 ..
<br />Santa Ana CA 92702
<br />AU RIZED REPRESENTATIVE
<br />.. "...
<br />CA '
<br />Todd Holliday
<br />k 1 C�+ P 1988 -2014 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2014101) Th tname and logo pardfe' registered marks of ACORD
<br />C!�'.'t° NO.: 214 aLr897 D,� 1 Dtyer 3/3/2314 e:s6.112 .AM {'nLY Paq; 3 of a
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