Laserfiche WebLink
AC 0 CERTIFICATE OF LIABILITY INSURANCE DATE(MMrDD,YYYY) <br />I1 /l/2€I16 10/20/2015 <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 CER'TIF'ICATE, 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 endorsement(s). <br />PRODUCER LGcktOn Companies CONTACT <br />444 W. 47th Not: Street, Suite 400 PHCNE C No FAX _ .. ............. <br />City .__ _ <br />Kansas City MCP 64112 -1906 E-MAIL Ext : IAIC, _ <br />(816) 960-9000 ADDRESS: <br />INSURER(S) AFFORDING COVERAGE NAIL # <br />_.__._.___.__......_.. .__...._._ INSURER A: Zurich American Insurance Company 16535 <br />INSURED BLACK & VEATCH CORPORATION INSURER B:American Zurich Insurance !Wgqpany 40142 <br />1058332 11441 LAMAR INSURER C: <br />OVERLAND PARK KS 66211 INSURER D <br />Bui Anti <br />INSURER T <br />INSURER F : ... <br />COVERAGES BLA"VF.T11 CERTIFICATE NIIMRFR• 11 kAZ (1St R;=o1IclAK1 Kit 1"RGp vvvvvvv <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 />AQQL <br />5Uf3ti'. <br />- _......... <br />POLICY EFF <br />POLICY NUMBER I MNIDQ,Y YV � <br />PULIC`1^"EXP... <br />(MMIQD <br />�....._�� .. <br />LIMITS <br />A <br />A <br />X <br />COMMERCIAL GENERAL IC <br />CLAIMS- MADE <br />Y <br />N <br />GLC4(K13SS <br />GLO4641367 <br />1111f2015 <br />11/1/2415 <br />1111/2016 <br />1111/241.6 <br />OCCURRENCE <br />1,000,000 <br />AMAGETORENTED ""'...$ <br />PREMISES Ea occurrence <br />$ 300,000 <br />X <br />MEDEXPtAny one person) <br />$ 10,000 <br />• <br />CONTRACTUAL _.... <br />(31-00139245 <br />11/112015 <br />ll /1/2016 <br />BFPD & C/O %rw.el w_..._ <br />..PERSONAL B,ADV INJURY <br />$ 1,000,000 <br />X <br />I.... <br />GEN <br />P <br />"L AGGREGATE LIMIT APPLIES PER_ <br />POLICY PIG- LOG. <br />JECT <br />GENERAL AGGREGATE <br />s 2 QI 0 000_._.., <br />PRODUCTS - COMP /OPAGG <br />$ 1 000 , 000 <br />OTHER: <br />I'i <br />$ <br />• <br />AUTOMOBILE <br />LIABILITY <br />N <br />N <br />BAP 4641355 (AOS) <br />1 11/1./201'5 <br />11/1/2016 <br />COMBINED SINGLE LIMIT <br />Ea aapidena <br />$ 1 000,000 <br />BODILY INJURY /Per person) <br />$ x�l'._x.x..�'.'xx <br />ANY AUTO <br />]xx <br />ALL OWNED -_ SCHEDULED <br />AUTO S AUTOS <br />BODILYINJURYIPeraccident)$ <br />.___ __ <br />xxi�xl�xx <br />NOWOWNED <br />HIRED AUTOS X AUTOS <br />Per a ciden/DAMAGE <br />$ xxxxxxx <br />$ xxxxxxx <br />UMBRELLA LIAR <br />OCCUR <br />NOT APPLICABLE <br />EACH OCCURRENCE <br />$ xxxxxxx . <br />EXCESS LIAR <br />CLAIMS -MADE <br />AGGREGATE <br />s xxxxxxx <br />DED RETENTION $ <br />$ xxxxxxx <br />B <br />A <br />A <br />WORKERS COMPENSATION <br />AND EMPLOYERS" LIABILITY <br />ANY PROPRIETOI�ARTNMEXECUTIVE YIN <br />OFFICERIMEMBEREXCLUDED? I <br />NIA <br />N <br />WC 46413$3 AOS) <br />WC 4641354 (WI & MA) <br />WC 0139244 <br />1111./2015 <br />11 //2015 <br />1111/2015 <br />1 I /1./2016 <br />11/112016 <br />11 /l /2016 <br />X S7ATLITE QRH -.. <br />.._ _..._.... <br />E.L. EACH ACCIDENT _ <br />- _ <br />__- <br />$ _100Q,000 <br />1001},000 I f <br />( ry ) <br />IfManclatory describe i NH) <br />DESCRIPTION OF OPERATIONS below <br />E.L. DISEASE - EA EMPLOYEE <br />_ — <br />E.L.. DISEASE - POLICY LIMIT /, <br />$ 1,000nQ 0 <br />$ 1000,000 <br />I <br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 501, Additional Remarks Schedule, may be attached if more space is required) <br />PN. 175203; Sanitary Sewer and Water Financial Plan REP. The City, its officers, employees, agents, volunteers and representatives are included as additional <br />insured on Gcneral Liability as required by written contract. <br />%1 n I irlkl, r e "W1- -Uen t,14,Ni r_LLAI1UPI ote iynaCnments <br />City of Santa Ana SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />220 S. Daisy Avenue, M -85 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />Santa Ana CA 9270 ACCORDANCE WITH THE POLICY PROVISIONS, <br />:3 <br />AUTHORIZED REPRESENTATIVE'' / <br />(� 19R��f1 daAf:t"IF1I7 C:CIRP(11�ATtt"YN fsll rnFsPc rncnnrnrV <br />ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD <br />e <br />