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CERTIFICATE OF LIABILITY INSURANCE
<br />DATE (MMIDD(YYYY)
<br />6/26/2017
<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 DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER($), 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
<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 />Alliant Insurance Services, Inc.
<br />333 Earle Ovington Blvd.
<br />Suite 700
<br />NAME. Forward All Certificate Revision Requests to
<br />PHONE the Below E -Mail FAX
<br />E -M AIL , NorthStarGroupServices@alliant.com
<br />INSURERS AFFORDING COVERAGE NAIC N
<br />Uniondale NY 11553
<br />INSURERA:National Union Fire Ins Co Pittsbur 19445
<br />Y
<br />INSURED
<br />INSURER B :American Guarantee and Liability In 26247
<br />NorthStar Demolition and Remediation, LP
<br />C:Navi ators Insurance Company 42307
<br />404 North Berry Street
<br />Brea, CA 92821-3104
<br />-INSURER
<br />INSURER D:New Hampshire insurance Com an 23841
<br />INsuRERE:Zurich American Insurance Company 16535
<br />INSURER F:AGCS Marine Insurance Company 22837
<br />COVFRAnFS CERTIFICATE NUMRER- 518$80832 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 />IXP
<br />LTE
<br />TYPE OF INSURANCE
<br />I
<br />POLICY NUMBER
<br />POLICY EFF
<br />POLICY
<br />LIMITS
<br />A
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE ❑X OCCUR
<br />Y
<br />Y
<br />GL 7468697 (AOS)
<br />GL 7468698 NY)
<br />7/1/2017
<br />711/2017
<br />7/1/2018
<br />7/112018
<br />EACH OCCURRENCE $2,000,000
<br />DAMAGE TO RENTED
<br />PREMISES Ea occurrence $300,000
<br />X
<br />MED EXP (Any one person) $25,000
<br />Contractual Liab
<br />PERSONAL & ADV INJURY $2,000,000
<br />AGGREGATE LIMIT APPLIES PER:
<br />GENERAL AGGREGATE $4,000,000
<br />GEN'L
<br />POLICY a JE� [7X LOC
<br />PRODUCTS -COMP/OPAGG $4,000,000
<br />$
<br />OTHER:
<br />A
<br />A
<br />AUTOMOBILE LIABILITY
<br />X ANYAUTO
<br />Y
<br />Y
<br />CA 3194561
<br />CA 3194562 (MA)
<br />7/1/2017
<br />7/1/2017
<br />7/1/2018
<br />7/1/2018
<br />EM MCBINE11, IN LIMIT $2,000,000
<br />BODILY INJURY (For person) $
<br />AUTOWNED SCHEDULED
<br />X WIRED AUTOUTOS
<br />S X NON -OWNED
<br />AUTOS
<br />BODILY INJURY (Per accident) $
<br />PROPERTY DAMAGE $
<br />Per accident
<br />B
<br />C
<br />X
<br />X
<br />UMBRELLA LIAR
<br />EXCESS LIAB
<br />X
<br />OCCUR
<br />CLAIMS -MADE
<br />Y
<br />Y
<br />SXS 0195929-01
<br />1817EXC9032381V
<br />7/1/2017
<br />7/1/2017
<br />7/1/2018
<br />7/1/2018
<br />EACH OCCURRENCE $25,000,000
<br />AGGREGATE $25,000,000
<br />DED RETENTION $
<br />$
<br />D
<br />D
<br />D
<br />DOFFICER/MEMBEREXCLUDED?
<br />D
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY YIN
<br />ANY PROPRIETOR/PARTNER/EXECUTIVEN
<br />(Manda(ory In NH)
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />NIA
<br />Y
<br />WC 014629471AOS)
<br />WC 014629472 IL,KY,NC)
<br />WC 014629473 NJ,PA
<br />WC 014629474 AZ,VA�
<br />WC 014629476 CA)
<br />WC 014629476 FL)
<br />7/1/2017
<br />7/1/2017
<br />7/1/2017
<br />711!2017
<br />711!2017
<br />7!1/2017
<br />7/1/2018
<br />7/112016
<br />7/1/2018
<br />7/1/2018
<br />711/2018
<br />711(2016
<br />X ST TUTS ERH
<br />_
<br />j
<br />E.L. EACH ACCIDENT !$1,000,000
<br />'—
<br />E.L. DISEASE - EA EMPLOYE $1,000,000
<br />E,L. DISEASE - POLICY LIMIT $1,000,000
<br />D
<br />E
<br />F
<br />Workers Compensation
<br />Poll/Prof Incl.Moid/Fungus/Asbest
<br />Leased/Rented Equipment
<br />Y
<br />Y
<br />y
<br />WC 014629477 (MA & MONO)
<br />PEC 0194414-0
<br />MX193060362
<br />7!112017
<br />7/1/2017
<br />7/1/2017
<br />7!1/2018
<br />7/1/2018
<br />7/1/2018
<br />$1,000,000
<br />Ea Claim: $10,000,000 Agg: $15,000,000
<br />Limit $1,500,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required)
<br />RE: On -Call Demolition Services.
<br />City of Santa Ana is included as Additional Insured on a Primary and Non -Contributory basis as respects General Liability, Automobile
<br />Liability, and Umbrella Llabllity as required by written contract, Waiver of Subrogation is included and applies in favor of the Additional Insured
<br />as required by written contract. _ _
<br />REVIEWED BY: � EUNICEw HEREDIA (PG � c�F )
<br />CERTIFICATE HOLDER CANCELLATION 30 Days Notice of Cancellation
<br />@ 1988-2014 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />City of Santa Ana
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />20 Civic Center Plaza (M-30), P.O. Box 1988
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />Santa Ana CA 92702-1988
<br />AUTHORIZED REPRESENTATIVE
<br />@ 1988-2014 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD
<br />
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