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A COMY CERTIFICATE OF LIABILITY INSURANCE
<br />DATE IMMI'D�YYYYy
<br />3/17/2015
<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 INSURERS), 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 />,3
<br />Greyling Insurance Brokerage
<br />3780 Mansell Road
<br />Suite 370
<br />Alpharetta CA, 30022
<br />NAME: Jerry Noyola
<br />PHONE . (770)552- 4.225 FAX N (866)5S0w94 a2
<br />E-MAIL erry.nayola greyling.com
<br />INSURER 5' AFFORDING COVERAGE
<br />INSURERA -Na3tional Union Fire Ixis �Co�19�445
<br />LIMITS
<br />INSURED
<br />Pet, maa8
<br />555 S. Flower Street
<br />Suite 4300
<br />i,or3 A,tl tiles CA 90071 1
<br />INSURER R :Travelers Property Casualty
<br />25674
<br />INSURERC
<br />INSURER 0:
<br />INSURERS:
<br />S 11000 , 000.
<br />INSURER F:
<br />CCOMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE OCCUR
<br />riTS'il� /1 aWn3�: �A =..•MIIM r1I.'Mr J, II0,1141= tZ911620 i'. ;�i �rrar Tt
<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
<br />LTR
<br />TYPE. OF INSURANCE
<br />ADDL
<br />SUBR
<br />POLICY NUMBER
<br />POLICY EFF
<br />M .
<br />POLICY EXP
<br />M I PD/rM
<br />LIMITS
<br />GENERALLIABIL.ITY
<br />EACH OCCU;RRENCE....
<br />S 11000 , 000.
<br />A
<br />CCOMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE OCCUR
<br />2047634
<br />/1/2015
<br />4/1/2016
<br />DAM) E EN ED
<br />PRFr.II s .a
<br />$ $00,000
<br />MEDFJIP(A.nyanapersan
<br />S. 25,000
<br />PERSONA4$ADVINJURY
<br />$ 1,000,000'.
<br />X Ccontractivall Liability
<br />GENERAL AGGREGATE
<br />$ 2,000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />PRODUCTS.- COMPIOPACG
<br />$ 2,,000,.000'
<br />POLICY, PRO- ,i LOO
<br />$
<br />AUTOMOBILE
<br />LIABILITY
<br />COMBINED SINGLE LIMIT
<br />a ac i i .,
<br />,,,,1,, 00Q 000
<br />ANY AUTO
<br />ALL OWNED SCHEDULED
<br />AUTOS AUTOS
<br />.HIRED AUTOS X NON•OWNEU...
<br />AUTOS
<br />3814893
<br />. /1/2075
<br />/1/2015
<br />BODILY INJURY (Pear Person)
<br />^�
<br />BODILY INJURY Per accident
<br />( )
<br />PROPER DAMAGE
<br />P ide,
<br />5
<br />UMBRELLA LIAO
<br />OCCUR
<br />EACH OCCURRENCE
<br />$..
<br />AGGREGATE.
<br />$
<br />EXCESS LIAR
<br />CLAWS -MADE
<br />DED I RETENTIONS
<br />$
<br />A
<br />A
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS" LIABILITY YIN
<br />ANY
<br />OFFi PERIMEMOER EXCLUDED? E'. UTIV ''.
<br />(Mandatory In NH)
<br />If yS descroe under
<br />DESCRIPPON OF OPERATIONS taelo,
<br />NIA
<br />399D1498 (ADS)
<br />39901499 (CA)
<br />/1/2415
<br />/1/2015
<br />/1/2015
<br />/1/2815
<br />x '. WCSTATU- OTH-
<br />fCL,l� ER
<br />E.L. EACH ACCIDENT
<br />--°-
<br />$ 0 000'
<br />E -L. DISEASE -EA EMPLOYE
<br />$ 1., 000 000
<br />E,L. DISEASE - POLICY LIMIT
<br />^
<br />$ 1,000,000
<br />DESCIUPTION OF OPERATIONS I LOCATIONS I VEHICLES (AnaO ACORD 101, Additional Remarks Sclaed0e, if more space is required)
<br />Re: 2SAN41,0111,p Walnut Pump Station upgrade Project. The City of Santa Ana, its officers, employees,
<br />agents, volunteers & representatives are named as Additional Insureds with respects to General Liability
<br />where required by written contract. The above referenced liability policies are primary &
<br />mean- contributory where required by written contract. Separation of insureds applies to the General
<br />Liability Policy. Waiver of Subrogation is applicable where required by written contract & allowed by
<br />law. Should any of the above described policies be cancelled by the insui.ng' insurer before the expiration
<br />date thereof, 30 days" written notice (except 10 days for nonpayment of premium) will be provided to the
<br />City of Santa Ana
<br />Study Rosas
<br />220 S. Daisy Avenue, -85
<br />Santa Asia, CA 92703
<br />SHOULD ANY OF TIIE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />AUTHORIZED REPRESENTATIVE.
<br />Col l inrd8 /JERRY
<br />AGILIKU 15 9,1II1W1ua} U 19BB -1010 ACORD CO!RPORATIOM All rights reserved.
<br />IN S025 (201005).01 The ACORD name and logo are registered niarks of ACORD 6-1"
<br />Iar' ca l Calµ- ,
<br />/
<br />
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