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ACORO
<br />CERTIFICATE OF LIABILITY INSURANCE
<br />OATE(MMIDDM Y)
<br />05'29'2014
<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 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(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 Central, Inc.
<br />Pittsburgh PA office
<br />CONTACT
<br />NAME:
<br />PHONE (866) 283 -]122 FI`X (800) 363 -01115
<br />(NC.No.Ext): AIC. ND.:
<br />Dominion Tower, 10th Floor
<br />625 Liberty Avenue
<br />E -MAIL
<br />ADDRESS:
<br />INSURER(S) AFFORDING COVERAGE
<br />NAICIf
<br />Pittsburgh PA 15222-3110 USA
<br />INSURED
<br />INSURERA: Liberty Mutual Fire Ins CO
<br />23035
<br />RBF COnSUltina
<br />PO BOX 57057
<br />Irvine CA 92619 -7057 USA
<br />INSURER R: Liberty Insurance Corporation
<br />42404
<br />INSURERC: National Union Fire Ins CO Of Pittsburgh
<br />19445
<br />INSURER D: Lloyd's Syndicate No. 2623
<br />AA1128623
<br />INSURER E:
<br />DAMAGE IU occu�iDU
<br />INSURER F:
<br />MED EXP(Any one person)
<br />COVERAGES CERTIFICATE NUMBER: 570053912702 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 />EXCLUSIONSAND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. Limits shown are as requested
<br />LTR
<br />TYPE OF INSURANCE
<br />INS'
<br />WVD
<br />POLICY NUMBER
<br />WDD EFF
<br />MMIDD
<br />POLIG E P
<br />MMIDO
<br />LIMITS
<br />GENERAL LIABILITY
<br />TB
<br />EACH OCCURRENCE
<br />$2,000,000
<br />%0MMERCIAL
<br />CLAIMS -MODE ❑X OCCUR
<br />DAMAGE IU occu�iDU
<br />$1,000,000
<br />MED EXP(Any one person)
<br />$5,000
<br />nimciuel
<br />X
<br />BFPD, XCU
<br />PERSONAL& ADV INJURY
<br />$2,000,000
<br />GEN'LAGGREGATE LIMITAPPLIESPER:
<br />GENERALAGGREGATE
<br />$4,000,000
<br />POLICY E] PRO JECT FX]LDC
<br />PRODUCTS - COMP/OP AGO
<br />$4,000,000
<br />OTHER:
<br />A
<br />AUTOMOBILE LIABILITY
<br />AS2- 681- 004145 -723
<br />06/30/2013
<br />06/30 /2014
<br />COMBINED SINGLE LIMIT
<br />E. accident
<br />$1,000,000
<br />BODILY INJURY (Per person)
<br />X ANYAUTO
<br />BODILY INJURY (Per acoldern
<br />ALL OWNED SCHEDULED
<br />AUTOS AUTOS
<br />NON -OWNED
<br />PROPERTY DAMAGE
<br />PREDAUTOS
<br />AUTOS
<br />Per accident
<br />C
<br />X
<br />UMBRELLALIAB
<br />X
<br />OCCUR
<br />BE018085867
<br />06/30/2013
<br />06/30/2014
<br />EACH OCCURRENCE
<br />$10,000,000
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />AGGREGATE
<br />$10,000,000
<br />LED I X
<br />RETENTION $10,000
<br />B
<br />WORKERS COMPENSATION AND
<br />WA768DO04145693
<br />0'/'0/' '1'
<br />06/30/2014
<br />.X I PER STATUTE J OTH-
<br />ER
<br />EMPLOYERS' LABILITY YIN
<br />ADS
<br />E.L. EACH ACCIDENT
<br />$1,000,000
<br />B
<br />ANY PROPRIETOR' PARTNER I EXECUTIVE
<br />F9
<br />NIA
<br />WC7681004145703
<br />06/30/2013
<br />06/30/2014
<br />OFFICEWMEMBER EXCLUDED?
<br />(Mandate, In NH)
<br />wI
<br />E.L. DISEASE -EA EMPLOYEE
<br />$1,000,000
<br />Ityes,descdbe under
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE - POLICY LIMIT
<br />$1,000,000
<br />D
<br />E &O -PL- Primary
<br />QC1302675
<br />06/30/2013
<br />06/30/2'14
<br />Per Claim
<br />$5,000,000
<br />Professional & Pollution
<br />Aggregate
<br />$5,000,000
<br />SIR applies per policy ter
<br />s & Bondi
<br />ions
<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 Water Resource Engineering services.
<br />The City of Santa Ana and its officers, employees, agents, volunteers, and representatives are included as Additional Insured
<br />on a Primary and Nan- Contributory basis, in accordance with the policy provisions of the General Liability policy.
<br />APR V
<br />CERTIFICATE HOLDER
<br />CANCELLATION ose Sandoval
<br />©1988 -2014 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD
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<br />SHOULD ANY i0lG U.tlaiUflIBBD G4I ®L�CPNeyLLEO BEFORE THE
<br />EXPIRATION DATE TH RE ,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE
<br />POLICY PROVISIONS.
<br />City of Santa Ana
<br />AUTHORIZED REPRESENTATIVE
<br />20 Civic Center PlaZa (M -30)
<br />P.O. BOX 1988
<br />Santa Ana CA 92702 USA
<br />©1988 -2014 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD
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