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A- 2014 - 130 -01
<br />CERTIFICATE OF LIABILITY INSURANCE
<br />r DATE.(MMIDDi"YY)
<br />1 09/1212014
<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(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 />AOn Risk Services Central, Inc.
<br />Pittsburgh PA Office
<br />CONTACT
<br />NAME:
<br />PHONE (8,66) 283 -7122 FAX 800) 363 -6145
<br />(AiC. No. Ext): AIC. No.):
<br />Dominion Tower, 10th Floor
<br />625 Liberty Avenue
<br />E -MAIL
<br />ADDRESS:
<br />INSURER(S) AFFORDING COVERAGE ,
<br />NAICIR
<br />Pittsburgh PA 15222-3110 USA
<br />INSURED
<br />INSURER A: Liberty Mutual Fire Ins CO
<br />23035
<br />RBF Consultinq
<br />PO Box 57057
<br />Irvine CA 92619 -7x57 USA
<br />INSURER IS: Lloyd's syndicate No. 2623
<br />AA1128623
<br />INSURER C; Liberty Insurance Corporation
<br />42404
<br />INSURER D: National U'n'ion Fire Ins co of Pittsburgh
<br />19445
<br />INSURER E:
<br />DAMAGE TO RENTED
<br />PREMISES Ea occurrence
<br />$1,000,000
<br />INSURER R
<br />MED EXP (Any one person)
<br />COVERAGES CERTIFICATE NUMBER: 570055112727 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. Limits shown are as requested
<br />INSR LTR
<br />TYPE OF INSURANCE
<br />INSO
<br />WVD
<br />POLICY NUMBER
<br />MM1DD
<br />MMf66!'YYl"M
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />TB
<br />EACH OCCURRENCE
<br />....$7,000,000
<br />CLAIMS -MADE ' OCCUR
<br />DAMAGE TO RENTED
<br />PREMISES Ea occurrence
<br />$1,000,000
<br />X.
<br />MED EXP (Any one person)
<br />_
<br />$5,000
<br />Contractual
<br />X
<br />BFPD', XCU
<br />PERSONAL & ADV INJURY
<br />$2,000,000
<br />CENT AGGREGATE LIMIT APPLIES PER
<br />GENERAL AGGREGATE
<br />$4,000, 000
<br />POLICY E PRO- � LOC
<br />JECT
<br />PRODUCTS - COMPfOP ACC......
<br />S4,000, 000
<br />OTHER'.
<br />A
<br />AUTOMOBILE LIABILITY
<br />000/2014
<br />08/30/7015
<br />COMBINED SINGLE LIMIT
<br />[Ea accident)
<br />51,000,000
<br />BODILY INJURY ( Per person)
<br />X ANY AUTO
<br />ALL OWNED SCHEDULED
<br />AUTOS AUTOS
<br />X HIRED AUTOS X NON -OWNED
<br />AUTOS
<br />BODILY INJURY (Per accident)
<br />PROPERTY DAMAGE.
<br />tPer accident.
<br />D
<br />X
<br />UMBRELLA LIAR
<br />X
<br />OCCUR
<br />BE018742918
<br />08/30,,!2014
<br />08 ✓30/2015
<br />EACH OCCURRENCE
<br />S10 „000,000
<br />EXCESS LIAR
<br />CLAIMS -MARE
<br />AGGREGATE
<br />$10 „000,000
<br />DED ' X RETEN710N 514',000
<br />C
<br />C
<br />WORKERS COMPENSATION AND
<br />EMPLOYERS' LIABILITY YIN
<br />ANY PROPRIETOR I PARTNER l EXECUTIVE
<br />OFMCERMEI,ABEREXCLUDED?
<br />VIA
<br />WA768DO04145694
<br />ADS
<br />wc7681004145704
<br />06/30/2014
<br />06/30/2014
<br />08✓30/2015
<br />08/36/2015
<br />X PER oTH-
<br />STATUTE. ER
<br />L.L. EACH ACCIDENT
<br />$1,000,000
<br />E L. DISEASE -EA EMPLOYEE
<br />$1,000,000
<br />(Mandatory in NHI
<br />WI
<br />If yes, describe under
<br />f3ESCRtlPTI0 N OF OPERATIONS below
<br />E.L. DISEASE- POLICY LIMIT
<br />51.,000,000
<br />B
<br />E &O-PL °Primary
<br />QC1402675
<br />06 ✓30/2014
<br />08/31/2015
<br />Per Claim
<br />ss,000,000
<br />Professional & Pollution
<br />Aggregate
<br />5s,aa0,(a00
<br />SIR applies per policy ter
<br />s & condi
<br />ions
<br />DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
<br />Re On -call Water Resource Engineering Services.
<br />The City of Santa Ana and its officers, employees, agents, volunteers, and representatives are included as Additional insured
<br />on a Primary and Non - Contributory basis, in accordance with the policy provisions of the General Liability policy.
<br />CERTIFICATE HOLDER CANCELLATION i
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE. THE
<br />EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE
<br />POLICY PROVISIONS.
<br />City Of Santa Ana, AUTHORIZED REPRESENTATIVE
<br />20 Civic center Plaza (M -30) p
<br />P.O. Box 1988 � tiMi� �,'i aatz
<br />Santa Ana CA 97.702 USA
<br />01988 -2014 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD
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