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AICQ,-�`c'� CERTIFICATE OF LIABILITY INSURANCE
<br />3/18/2014
<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 />Greyling Insurance Brokerage
<br />450 Northridge Parkway
<br />Suite 102
<br />Atlanta GA 30350
<br />CONTACT Jerry NOyola
<br />PHONE (770)552-4225 FAX , (866)550-6082
<br />EW Lss•7grry. noyola@gryeling. Dom
<br />INSURERS AFFORDING COVERAGE NAIC N
<br />INSURER ANational. Union Fire Ins Cc 19445
<br />INSURED
<br />POWER Engineers, Inc.
<br />3940 Glenbrook Drive
<br />P,O. .BOX 1066
<br />Hailey ID 83333
<br />INSURERBNOW Hampshire Insurance Company 6247
<br />INSURER CS ndicate 2623'.623 at Lloyd's
<br />INSURER D:
<br />INsu ERE:
<br />su F:
<br />COVERAGES CERTIFICATE NUMBER:14-15 (PHI) 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 />INSR_POLICYEFF
<br />LTR
<br />TYPE OF INSURANCE
<br />POLICY NUMBER
<br />O YYY
<br />POLICYEXP
<br />YYY
<br />LIMITS
<br />GENERAL LIABILITY
<br />_
<br />EACH OCCURRENCE $ 1,000,000
<br />A
<br />X COMMERCIAL GENERAL LIABILITY
<br />CLAIMS�MADE M OCCUR
<br />3L 5084741
<br />4/1/2014
<br />4/1/2015
<br />PREMISES E. cocum,nual $ 500,000
<br />MED EXP (my:one person) $ 25,000
<br />PERSONAL&ADV INJURY $ 1,000,000
<br />X Contractual Liability
<br />_
<br />GENERALAGGREGATE $ .2,000,000
<br />GENL AGGREGATE
<br />LIMIT APPLIES PER
<br />PRODUCTS - COMPIOP AGO $ 2,000,000
<br />POLICY
<br />FX PRO- X LOC
<br />$
<br />AUTOMOBILE
<br />LIABILITY
<br />COMBINED SINGLE SIN LE LIMIT 1,000,000
<br />BODILY INJURY(Per person) S
<br />A
<br />A
<br />X
<br />X
<br />ANY AUTO.
<br />AAUTOOSMED AUTpSULED
<br />HIRED AUTO Y" NON -OWNED
<br />TOS
<br />A. 6403759 (AOS)
<br />A 6403760 (NA)
<br />4/1/2014
<br />4/1/2014
<br />4/1/2015
<br />4/1/2015
<br />BODILY INJURY (Per accident) $
<br />PROPERTY DAMAGE
<br />Wela"Id.nd) $
<br />UMBRELLA LIAR
<br />OCCUR
<br />EACHOCCURRENCE $
<br />AGGREGATE $
<br />EXCESS LIAR
<br />CLAIMS -MADE
<br />050 1 1 RETENTION$$
<br />B
<br />A
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY YIN
<br />NY PR IMEIMBER EXCLUDRIEXECUTIVE F
<br />OrF
<br />(Mandatory In NH}
<br />NIA
<br />9C 049901174 (AOS}
<br />049901175 (CA)
<br />4/1/2014
<br />4/1/2014
<br />4/1/2015X
<br />4/1/2015
<br />WGSTA7U- OTH-
<br />E.L. EACH ACCIDENT S 1,000,000
<br />E.L. DISEASE - EA EMPLOYEf $ 1,000,000
<br />If desoibe F
<br />E.L. DISEASE -POLICY LIMIT $ 11000,000
<br />DESCRIPTION OOPERATIONS below
<br />C
<br />Professional Liability
<br />913B97140201
<br />4/1/2014
<br />4/1/2015
<br />Per Claim $5,000,000
<br />Aggregate $5,000,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is required)
<br />The City of Santa Ana, its officers, employees, agents, volunteers & representatives are named as
<br />Additional Insureds on the above referenced liability policies with the exception of workers compensation
<br />& professional liability where required by written contract. Should any of the above described policies
<br />be cancelled by the issuing insurer before the expiration date thereof, 30 days' written notice (except
<br />10 days for nonpayment of premium) will be provided to the Certificate Holder named below.
<br />0"
<br />CERTIFICATE HOLDER , TS.a r__ � CANCELLATION
<br />oq
<br />I
<br />et' `�. vv � I
<br />2 p Q(i
<br />City of Santa Ana L ���P -".4 �I�OT�'y
<br />Purchasing Department,.-- s�5NV" 7
<br />20 Civic Center Plaza Ng..` i jr�'
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL SE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS,
<br />AUTHORIZED REPRESENTATIVE
<br />Santa Ana, CA 92701 t_.
<br />�7
<br />David Collings/JERRY
<br />ACORD 25 (2010/05)
<br />IN 5025 ,,trine, m
<br />© 1988.2010 ACORD CORPORATION. All rights reserved.
<br />Tho 4r.imI nam. and Innn .r. r.rvlcbmA marlre of Ar.npn
<br />
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