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<br />CERTIFICATE OF LIABILITY INSURANCE
<br />OATE(MMIDD/YYYYI
<br />11123/2015
<br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.. THIS
<br />CERTIFICATE DOES INOT 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) 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 endorsoment(s).
<br />PRODUCER
<br />Aon Risk Services Central, Inc.
<br />Pittsburgh PA office
<br />CONTACT
<br />NAME:
<br />PHONE(8616) 283-712:2. FAX (800) 363-0105
<br />.(AIC. No.Ext): (AIC. No.:.
<br />E. -MAIL
<br />ADDRESS:
<br />Domin"ions Tower„ loth Floor
<br />625 Liberty Avenue
<br />INSURER(5) AFFORDING COVERAGE NAIL #
<br />Pittsburgh PA 1522.2-3110 USA
<br />INSURED
<br />INSURER A: Liberty mutual Fire Ins Co 23035
<br />Michael Baker I:nternat-ional, Inc.
<br />INSURER B: Liberty Insurance Corporation 42404
<br />P() Box 57057
<br />Irvine CA 92619-7057 USA
<br />INSURER C: National union Fire Ins co of Pittsburgh 19445
<br />INSURER D: Lloyd's Syndicate No. 2623 AA1128623
<br />INSURER E:
<br />INSURER F: ,
<br />CLAIMS -MADE � OCCUR
<br />COVERAGES CERTIFICATE NUMBER: 570060247550 REVISION NUMBER:'
<br />a
<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 />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
<br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR. OTHER DOCUMENT WITH RESPECT TO WHICH THIS
<br />EXPIRATION DATE THEREOF, NOTICE WILL BE
<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. Limits shown are as requested
<br />...LIMITS
<br />INSR
<br />LTR
<br />TYPE. OF INSURANCE.
<br />ADDL
<br />INSO
<br />SUER
<br />WV'D
<br />POLICY NUMBERMMIDDIYYYY
<br />POLICY EFF
<br />POLICY EXP
<br />MMIDDIYYYY
<br />A
<br />X COMMERCIAL. GENERAL LIABILITY
<br />TBS...
<br />EACH 9CCURR,ENCE $2,000,000
<br />CLAIMS -MADE � OCCUR
<br />DAMAGE O RIEN..
<br />., D $100, 000
<br />PREMISES Ea occurrence)
<br />MED EXP (Any ou e persony s s , 000
<br />X Contractual Liability
<br />PERSONAL A ADVINJURY $2,000,000
<br />.
<br />GEN'L. AGGREGATE LIMIT APPLIES PER.
<br />GENERAL AGGREGATE $4,000,0
<br />POLICY L PRa- � LOC
<br />JIECT
<br />PRODUCTS - COMP',IOP AGO $4,000,000
<br />OTHER:
<br />�
<br />M
<br />A
<br />AUTOMOBILE. LIABILITY
<br />A52-681-004145-725
<br />08%30/201.5
<br />0.,8/30/2016
<br />COMBINED SINGLE LIMIT
<br />Ea accident) $1,000,000
<br />�
<br />BODILY INJURY ( Pec person)
<br />X ANY AUTO
<br />ALL. OWNED SCHEDULED
<br />Z
<br />BODILY INJURY (Pecaccident),
<br />AUTOS AUTOS
<br />NON -AWNED
<br />ra
<br />RRCPERTY DAMAGE
<br />X HIRED AUTOS X
<br />AUTOS
<br />Per accident)
<br />4=;
<br />dl
<br />C
<br />X
<br />UMBRELLA LIAR
<br />X
<br />OCCUR
<br />BED33086983...
<br />08/.30/2015
<br />08/30/2016
<br />EACH OCCURRENCE $10,000,000
<br />.
<br />EXCESS LIAR
<br />CLAIMS -MADE
<br />AGGREGATE $10,000,000
<br />DED I X RETENTION 3147„410t➢
<br />B
<br />WORKERS COMPENSATION AND
<br />WWA768DO04145775
<br />08/30/"2015
<br />08/30/2015
<br />x Sf.4'1'UTE. .....ETH
<br />EMPLOYERS' LIABILITY Y 1 N
<br />AOS
<br />E-1EACH ACCIDENT $1 , 000, 000
<br />B
<br />ANY PROPRbETCR f PARTNIER f Ex.ECUTIVE
<br />N1A
<br />WC7681004145785
<br />08/30/2015
<br />08/30/2016
<br />OFFICERtMEMBEREXCLLJDED?
<br />(Mandatory in NH)
<br />Wk
<br />E.. L. DISEASE -EA EMPLOYEE $1,000,000
<br />9 ye 5. describe under
<br />E L, DISEASE -POLICY LIMIT $1,000,000
<br />DESCRIPTION OF OPERATIONS below
<br />D
<br />E&C-PL-Primary
<br />r1C1502675
<br />08/31/2015
<br />08/31/2016
<br />Per Claim 55,000,000
<br />Professional & Pollution
<br />Aggregate $5,000,000
<br />SIR applies per policy teres
<br />& condi
<br />ions
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES IACORD 101, Additional Remarks Schedule, may be attached it more space is required)
<br />For Named Insured only: Attn: Kim Hartsfield, RE'.; on-call'Engineering Services, A-2013-014-01 and A-2015-170, RFP No.
<br />14-037. city of Santa Ana, its officers, employees, agents and representatives are included as Additional insured in
<br />accordance with the policy provisions of the General Liability policy. General Liability policy evidenced herein is Primary
<br />and Non -Contributory to other insurance available to an Additional Insured, but only in accordance with the policy's
<br />d Non -ns. should
<br />p' General Liability, Automobile Liability and Workers' Compensation policies be cancelled )before the
<br />expiration date there of, the policy provisions will govern how notice of cancellation may be delivered to certificate holders
<br />in accordance with, the policy provisions.
<br />m—
<br />CERTIFICATE HOLDER
<br />CANCELLATION'
<br />@198872014 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2014101) The ACORD name and logo are registered mark of ACORD
<br />Fll=:Vlt_/VLD BY: � r �. I-:I..IIWWiCE HE RIE )IA (PG I OF �.)...
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
<br />EXPIRATION DATE THEREOF, NOTICE WILL BE
<br />DELIVERED IN ACCORDANCE WITH THE
<br />POLICY PROVISIONS.
<br />City of Sanaa Ana
<br />AUTHORIZED REPRESENTATIVE
<br />20 CiviC Centel” Plaza (M-30)
<br />PO Box 1988
<br />Santa Ana CA 92.702-1988 USA
<br />@198872014 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2014101) The ACORD name and logo are registered mark of ACORD
<br />Fll=:Vlt_/VLD BY: � r �. I-:I..IIWWiCE HE RIE )IA (PG I OF �.)...
<br />
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