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A 2-i'0 INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS DATF(MM/Di 09)2312016 CERTIFICATE OF LIABILITY INSURANCE I THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS INSIR LTR CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES ADDL INSO BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED Lexington Insurance Company REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. 0 U_ IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policyi must have ADDITIONAL INSURED provisions or be endorsed. INSURER B: If SUBROGATION IS WAIVED, subject to the terms and conditions of the Policy, Certain policies may require an endorsement. A statement on 19445 this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT 19429 Aon Risk insurance Services West, Inc. 0 -NAME: FAX — PHONE (866) 283-7122 (800) 363-0105 Los Angeles CA office �AJC. No. Ext): 'a 1 707 Wilshire Boulevard 0 Suite 2600 ADDRESS: $1,000,000 INSURER F: _fR MED EXP (Any one person) Los Angeles CA 90017-0460 USA COVERAGES CERTIFICATE NUMBER: 570063791493 INSURER(S) AFFORDING COVERAGE NAIC # THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, Limits shown areas requested INSIR LTR INSURED ADDL INSO 1 INSURER A: Lexington Insurance Company 19437 Tetra Tech, Inc. I LIMITS INSURER B: National union Fire Ins Cc of Pittsburgh 19445 17885 von Karmen Ave. Ste. 500 INSURER C: The Insurance Co of the State of PA 19429 Irvine CA 92614 USA $1,000,000 INSURER D: American Home Assurance Co. 19380 INSURER I AIG Europe Limited AA1120841 DAMAGE T1,1 RENTED Ea accureenee $1,000,000 INSURER F: _fR MED EXP (Any one person) $10,000 COVERAGES CERTIFICATE NUMBER: 570063791493 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, Limits shown areas requested INSIR LTR TYPE OF INSURANCE ADDL INSO B WVD POLICY NUMBER POLICY EFF MMI T POLICY EXP MMIDDNYYY IMID�iy LIMITS 13 X COMMERCIAL GENERAL LIABILITY 220 S. Daisy Avenue, Suite A Santa Aria CA 92703 USA GL6051604 1777 64 I EACH OCCURRENCE $1,000,000 CLAIMS -MADE. OCCUR DAMAGE T1,1 RENTED Ea accureenee $1,000,000 X _fR MED EXP (Any one person) $10,000 X,C,U coverage PERSONAL &. ADV INJURY $1,0100,000 GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $1,000,000 POLICY E,,R�OT FXJ LOC PRODUCTS - COI AGO sl.,000,000 OTHER. 8 AUTOMOBILE LIABILITY CA 319-45-11 10/01/2016 10/01/2017 COMBINED SINGLE LIMIT (Ea aocidenI $1,000,000 BODILY INJURY { Per I X ANY AUTO BODILY INJURY (Per accident) OWNED SCHEDULED AUTOS ONLY AUTOS HIRED AUTOS NON- OWNED ONLY AUTOS ONLY IX PROPERTY DAMAGE (Per accident) ISO Policy Form CAP I I X UMBRELLA i IHI OCCUR TH1600053 10/01/2016 1010112017 EACH OCCURRENCE $10,06-0,000 EXCESS I CLAIMS-MADE AGGREGATE $10,000,000 _5EFF 7,,E7ENTION S100, 000 C D C C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR PARTNER ttCu,lvE I OFFICERWE!i EXrLUDEi I (Mandatory in I NIA wC014629374 wc014629378 sC014629379 WC014629380 10/01/2016 10/01/2016'10/01/2017 10/01/2016..10/01 10/01/201610/01 1010112017 /2017 /2017 X � PER 0 TH- ,,A i ER 1 1 E L. EACH ACCIDENT $1,000,000 FL DISEASE-FA EMPLOYEE $1,000,000 If yes describe under DESCRIPTION OF OPERATIONS below I L DISEASE - POLICY LA41T $1,000,000 A Env contr Prof 028182375 10/01/2015 IG/01/2017 Each claim $5,000,000 Prof/Poll I Agggregate SIR applies per policy terns & condi ions DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) RE: San Lori Lift Station project. City of Santa Ana-Public works Agency its officers employees, agents, volunteers and representatives are included as Additional Insured in accordance with Ne policy provisions of the General Liability policy as required by written contract, General Liability policy evidenced herein is Primary and Non-Contributory to other insurance available to an Additional insured, but only in accordance with the policy's provisions as required by written contract. Stop Gap coverage for the following states: OH, I i WY, -,)2,e,- I k icl CERTIFICATE HOLDER CANCELLATION 01988-2015 ACORD CORPORATION. All rights reserved, ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLEO BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Santa Ana-Public works Agency AUTHORIZED REPRESENTATIVE Attn: Ri I 220 S. Daisy Avenue, Suite A Santa Aria CA 92703 USA 01988-2015 ACORD CORPORATION. All rights reserved, ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD