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CERTIFICATE I ILIT`Y
<br />dAT[1O12512B
<br />I U A
<br />5YYY,
<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(ies) nLust be endorsed. If SUBROGATION IS WAIVED, subject to
<br />the terms and conditions of the polscy, 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 I.nsur-ance Services West,Inc.-NAME:
<br />Los Angeles CA Office
<br />707 Wilshire Boulevard
<br />:Suite 2000
<br />Los Angeles CA 9001.7-0460 USA
<br />CONTACT
<br />PHONE (&fi&) 283-7122 FAX
<br />(A C. No. Ezt): Ip c. No,}; (800) '63-0105
<br />105
<br />E-MAIL
<br />ADDRESS:
<br />GL
<br />INSURER(S) AFFORDING COVERAGE MAIC #
<br />INSURED
<br />178.6, Tech„ Inc.ma(n Ave.e
<br />17885 Von Karrlla.
<br />INSURER A: National Onion Fire. Ins Co of Pittsburgh 1944.5
<br />INSURER B::IAR)_ The Insurance CO Of the state of PA 19479
<br />INSURER C: AIG LUrope Limited _ AA1..120841.
<br />_._
<br />'.ate. 500`
<br />`
<br />Irvine CA 92614 USA
<br />INSURER D: Lexington Insurance Company 19437
<br />INSURER E:
<br />INSURER F:
<br />r k1PPii(": 'Q (^C0TIrIMNTf-All
<br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY
<br />PERIOD
<br />INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO
<br />WHICH THIS
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREINIS SUBJECT
<br />TO ALL THE TERMS,
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />Limits shown are as requested
<br />AINSD SUBR
<br />LTR TYPE OF INSURANCE WVD POLICY NUMBER OLICY E F POLICYEXP
<br />MMIDDR'YYY MIZdUOfYYYY LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />GL
<br />1 / -1 _U15
<br />1.
<br />EACH OCCURRENCE S2,000,0
<br />CLAIMS -MADE OCCUR
<br />PREMISESRFRiaoctuE®ncc} $1,000,000
<br />X
<br />X,C,U Couerage
<br />MED EXP (Any one person) _�. S10,000
<br />PERSONAL$ AOV INJURY $2,000,000'.
<br />GF.N'L AGGREGATE LIMITAPPLIES PER
<br />GENERAL AGGREGATE $4,000,000
<br />POLICY X PRO. ;{ L.00
<br />PPODUCTS-COMNOPAGG '$4,.000,000
<br />JEGT I
<br />OTHER'
<br />A
<br />AUTOMOBILE LIABILITY
<br />CA 3194397
<br />10/01/24115
<br />1010112016
<br />COMBINED SINGLE LIMJIT
<br />(Ea accidant .€2.,000,000
<br />BODILY INJURY (Per person)
<br />XANY AUTO
<br />ALL OWNED SCHEDULE.G'.
<br />AUTOS AUTCJS
<br />BODILY INJURY (Per accident)
<br />X HIRED AUTOS X..: NON -OWNED
<br />PRDPERTY DAMAGE
<br />AUTOS
<br />6Per accident)
<br />X 150 Policy Form CA
<br />°
<br />X
<br />UMBRELLA LIAR I X OCCUR
<br />THlSO0079
<br />10/01/2015
<br />10/01/2016
<br />EACH OCCURRENCE 55,000,000,
<br />EXCESS LIAR CLAIMS -MADE
<br />AGGREGATE $51000,000
<br />.WORKERS
<br />OED. X ON $100,000
<br />B
<br />'.
<br />COMPENSATION AND
<br />WC014267906
<br />10/01/2015
<br />10/01/2016''
<br />PER
<br />X NR OTH-
<br />B
<br />EMPLOYERS' LIABILITY YIN
<br />WC014267908
<br />10/01%201$.10/01/2016
<br />ATUTE
<br />B
<br />ANY PROPRIETOR f PARTIJER 1 ExECUTIVE
<br />OFF'EXCLUDE07
<br />NIA
<br />WC014267907
<br />10/01/2015
<br />10101/2016
<br />LL EACH ACCIDENT S1,000,000
<br />B
<br />.I yes,
<br />I1yes,c scry be0.
<br />O
<br />101011201510/01/2016
<br />EL.DISEASE-EAEMPLOYEE $1,000,000
<br />IPTIOZ OF
<br />DESCRIPTION OF OPERATIONS below
<br />IWCO?.4267912
<br />E.L DISEASE -POLICY LIMIT $1, 000 000 _
<br />D
<br />contractor Prof
<br />0281_82375
<br />10/01/2015
<br />10/01/2017
<br />,
<br />Each Claim $5,0011 400 -
<br />Prof/poll Li ah
<br />Agggregate $5,000,000
<br />SIR applies per policy ter
<br />s & ro�ndi
<br />ions
<br />DESCRIPTION OF OPERATIONS I LOCATIONS J VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is requirecd) d°
<br />RE:. Project: San Lorenzo Sewer Lift station, 1.34P00597-0085-00. City of Santa Ana, its offic..ers, agents, volunteers and "g
<br />represenTatives are included as Additional insured with respect: to the General Liability policy as required by written �
<br />contract. General Liability coverage evidenced herein is Primary and Non -Contributory to other insurance available
<br />to an
<br />Additional Insured, but only in accordance with the policy's provisions. stop Gap Coverage for the following state's::
<br />WY, Nd. OH, WA,
<br />H
<br />CERTIFICATE HOLDER CANCELLATION
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES RE CANCELLED BEFORE THE S
<br />EXPIRATION DATE THEREOF, NOTICE WILL, BE DELIVERED IN ACCORDANCE WITH THE
<br />POLICY PROVISIONS,
<br />City Of Santa Ana
<br />Public Works Agency
<br />AUTHORIZED REPRESENTATIVE.. ®"
<br />Attn:: Cesar E. Barrer,
<br />220 S. Daisy Aue., USA
<br />Santa Ana CA 92702 USA
<br />a& � i
<br />i✓'. 7�,?dd�xaacG Pe�2r�Cw'7 axcor
<br />Q1988.2014 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2014101) The ACORD name and iogo are registered marks of ACORD
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