|
ACC?/2�
<br />�.� CERTIFICATE OF LIABILITY INSURANCE
<br />DATE(MMIDO/YVYY)
<br />0(MMIDO
<br />14
<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
<br />BELOW, THIS CERTIFICATE OF INSURANCE 0055 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(les) 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
<br />AOn Risk Services Northeast, Inc.
<br />Morristown N7 Office
<br />CONTACT
<br />NAME:
<br />ac.Ne. E at). (8GG) 263_7122 ANC Na :800 -363 -0105
<br />44 Whippany Road, Suite 220
<br />Morristown NJ 07960 USA
<br />E.MWL
<br />ADDRESS:
<br />INSURER() AFFORDING COVERAGE
<br />NATO
<br />INSURED
<br />INSURER A: Zurich American Ins CO
<br />16535
<br />AMEC Environment & IDfrastructure, Inc.
<br />121 innovation Drive, Suite 200
<br />Irvine CA 92611 USA
<br />INSURER B: ACE American insurance Company
<br />22667
<br />INSURER C: ACE Property & Casualty Insurance Co.
<br />20699
<br />INSURER D: American Zurich ins Co
<br />40142
<br />INSURER E:
<br />PREMISES ma occurrence
<br />INSURER F:
<br />MED EXP(Any one parson)
<br />COVERAGES CERTIFICATE NUMBER: 570054284065 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. Limits shown are as requested
<br />TYPE OF INSURANCE
<br />ADDL
<br />So
<br />=a
<br />POLICY NUMBER
<br />MMIDDIYYYY
<br />MMIDDM/W
<br />LIMITS
<br />NZ
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />HDOG 5
<br />1/1
<br />EACH OCCURRENCE
<br />$1,000,000
<br />GIAIMS -MADE ❑X OCCUR
<br />PREMISES ma occurrence
<br />$100,000
<br />MED EXP(Any one parson)
<br />$10,000
<br />PERSONAL &ADV INJURY
<br />$1,000,000
<br />GEN'L AGGREGATE LIMI f APPLIES PER:
<br />GENERALAGGREGATE
<br />$1,000,000
<br />POLICY PRO, LOC
<br />JECT
<br />PRODUCTS- COMP/OP AGO
<br />$1,000,000
<br />OTHER',
<br />A
<br />AUTOMOBILE LIABILITY
<br />BAP9493148 -03
<br />05/01/201405/01
<br />/2015
<br />COMBINED SINGLE LIMIT
<br />Ea accident
<br />$1,000,000
<br />BODILY INJURY(Pm,dm.r)
<br />_
<br />X ANYAUTO
<br />BODILY INJURY (Per accident)
<br />X ALLOWNED SCHEDULED
<br />AUTOS AUTOS
<br />X HIRED AUTOS X NON,OWNED
<br />PROPERTY DAMAGE
<br />Per eccitlent
<br />AUTOS
<br />% Cell Ded $1000 OamP den $1000
<br />C
<br />X
<br />UMBRELI-ALIAB
<br />X
<br />OCCUR
<br />xooG27 38671
<br />05/01/2014
<br />05/01/2015
<br />EACH OCCURRENCE
<br />$1,000,000
<br />AGGREGATE
<br />$1,000,000
<br />EXCESS LIAB
<br />CLAIMS-MADE
<br />BED I X
<br />IRETENTION $10, 000
<br />D
<br />WORKERS COMPENSATION AND
<br />WE $0486613
<br />05/01/2014
<br />05/01/2015
<br />X `PTATUTE ERH
<br />EMPLOYERS' LIABILITY YIN
<br />All other States
<br />E,L. EACH ACCIDENT
<br />$1,000,000
<br />D
<br />ANYPROPRIETOR /PARTNER /EXECUTIVE
<br />NIA
<br />WC366713307
<br />1)5/01/2014
<br />0$/01/2015
<br />OFFICERIMEMBER E %CWDEO9
<br />IManUateryin NH)
<br />MA & WI
<br />E.L. DISEASE -EA EMPLOYEE
<br />$1,000,OOD
<br />If yes describe under
<br />DESCRIPTION OF OPERATIONS below
<br />ET'DISEASE- POLICY LIMIT
<br />$1,000,000
<br />A
<br />Archit &Eng Prof
<br />EOC938357806
<br />05/01/2014
<br />05101/2015
<br />Any one Claim
<br />$1,000,000
<br />SIR applies per policy ter
<br />r & condi
<br />ions
<br />Aggregate
<br />$1,000,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES pCORD 101, Additional Remarks Schedule, may be crashed if more apace is required)
<br />RE: Project Description: NPOES Inspection and Database Management Services, city of Santa Ana, its officers, employees, agents,
<br />volunteers and representatives are included as Additional insured in accordance with the policy provisions of the General
<br />Liability Policy. General Liability Policy evidenced herein is Primary and Non - Contributory to other insurance available to
<br />City of Santa Ana, its officers, employees, agents, Volunteers and representatives, but only in accordance with the policy's
<br />provisions.
<br />CERTIFICATE HOLDER
<br />CANCELLATION
<br />d
<br />c
<br />w
<br />a
<br />,a
<br />S
<br />2
<br />N
<br />4.
<br />t'
<br />d
<br />U
<br />�J
<br />`EY
<br />�7
<br />Nano
<br />yY
<br />J_
<br />E�lr
<br />I
<br />91888.2014 ACORD CORPORATION. A 6Ig ,cp$A�ped
<br />ACORD 25 (2014/01) The ACORD name and logo are registered marks of AC(�ROVE— (.J VI11Y1
<br />USA E. STORCK d(
<br />Assistant City Attorney
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES Be CANCELLED BEFORE THE
<br />EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE
<br />POLICY PROVISIONS.
<br />City Of Santa Ana
<br />AUTHORIZED REPRESENTATIVE
<br />20 Civic Center Plaza
<br />Santa Ana CA 92702 USA
<br />c.NXO7a tiJLtOK �iL2YCed c/ /Pb %�CU9f ✓7zu
<br />d
<br />c
<br />w
<br />a
<br />,a
<br />S
<br />2
<br />N
<br />4.
<br />t'
<br />d
<br />U
<br />�J
<br />`EY
<br />�7
<br />Nano
<br />yY
<br />J_
<br />E�lr
<br />I
<br />91888.2014 ACORD CORPORATION. A 6Ig ,cp$A�ped
<br />ACORD 25 (2014/01) The ACORD name and logo are registered marks of AC(�ROVE— (.J VI11Y1
<br />USA E. STORCK d(
<br />Assistant City Attorney
<br />
|