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ACC>R& CERTIFICATE OF LIABILITY INSURANCE
<br />DATEIMMIDDfYYYY)
<br />01/21/2016
<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 polcy(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 LICENSE NO. 0637431
<br />CONTACT
<br />NAME: PATRICK MCRAE
<br />PATRICK MCRAE INSURANCE SERVICES
<br />1290 N. HANCOCK ST., SUITE 210
<br />PHONE (714) 779 -6999 AJC Na : (7'14) 779 -6'903
<br />E -MAIL
<br />ADDRESS: p.mcrae@slbcglobal.net
<br />ANAHEIM'' HILLS, CA 92.807
<br />INSURER S AFFORDING COVERAGE
<br />NAIC #
<br />INSURER A: BURLINGTON INSURANCE COMPANY
<br />23620
<br />INSURED
<br />INSURER B: INSURANCE COMPANY OF THE WEST
<br />2.7847
<br />INSURER C; CENTURY- NATIONAL INSURANCE CO.
<br />2.6905
<br />X
<br />CROSSTOWN ELECTRICAL & DATA, INC.
<br />5463 DIAZ STREET
<br />IRWINDALE CA 91706
<br />INSURER D: GREAT AMERICAN INS CO OF NY
<br />22136
<br />INSURER E: GREAT AMERICAN INSURANCE COMPANY
<br />16691
<br />INSURER F:
<br />COVERAGES CERTIFICATE NUMBER: 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 />INTRR.
<br />TYPE OF INSURANCE
<br />INSDL
<br />SURD
<br />POLICY NUMBER
<br />MMIDIYYYY
<br />POLICY IIYYYY
<br />......LIMITS
<br />A
<br />X
<br />COMMER.MAL GENERAL LIABILITY
<br />CLAIMS -MADE OCCUR
<br />XCU
<br />X
<br />X
<br />HGL004151 6
<br />DEDUCTIBLE..:
<br />$5,000 PER OCC
<br />.06/03/201506/03/2016
<br />EACH OCCU CE RREN
<br />l$ 1'000'000
<br />DAMAGE TO RENTED
<br />PREMISES Ea occurrence
<br />$ 50,000
<br />X
<br />MED EXP (Any one person)
<br />$ 0,000
<br />X
<br />OCP'
<br />PERSONAL & ADV INJURY
<br />$ 1,000,000
<br />AGGREGATE UMIT APPLIES PER:
<br />PRO-
<br />POLICY II JECT 0 LOC
<br />GENERAL AGGREGATE
<br />$.. 2,000,000
<br />GEN'L
<br />PRODUCTS - COMPIOP AGG
<br />$ 2,0'00,000
<br />I�
<br />$
<br />OTHER
<br />C
<br />AUTOMOBILE
<br />UABILITY
<br />X
<br />BAP0171987
<br />11/05/201511/05
<br />/2.016
<br />COMBINED SINGLE LIMIT
<br />Ea accident
<br />$ 1,000,OC10
<br />X
<br />BODILY INJURY (Per person)
<br />'��, $ -
<br />ANY AUTO
<br />ALL OWNED SCHEDULED
<br />AUTOS X AUTOS
<br />HIRED AUTOS v NON -OWNED
<br />AUTOS
<br />X
<br />BODILY INJURY (Per accident)
<br />$ _
<br />PROPERTY DAMAGE
<br />Per accident.
<br />$ -
<br />$
<br />E
<br />—x],
<br />UMBRELLA LIAR
<br />EXCESSLIAB
<br />X
<br />OCCUR
<br />CLAIMS -MADE
<br />TUE429515200
<br />UNDERLYING LIMITS:
<br />GL; AL; EL POLICIES
<br />06/03/2015
<br />06/0312018
<br />OCCURRENCE
<br />$ 10,000,0100
<br />X
<br />AGGREGATE
<br />$ 10,000,000
<br />DED RETENTION$ 0
<br />.EACH
<br />-
<br />B
<br />WORKERS COMPENSATION
<br />......
<br />AND EMPLOYERS' LIABILITY YIN
<br />ANY PROPRIETORIPARTNER(EXEDUTI..
<br />OFFICER/MEMBER EXCLUDED?
<br />IMaradatory in NH)
<br />If es, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />N f A
<br />x
<br />WLV503035400
<br />06/03/2015
<br />06/03/2016
<br />U
<br />X.1 STATUTE ©RH
<br />E.L. EACH ACCIDENT
<br />$ 1,000,000
<br />: E.L. DISEASE - EA EMPLOYEE
<br />$ 1,000,000
<br />E.L. DISEASE -POLICY LIMIT
<br />$ 1,000,000
<br />D
<br />BUSINESS OWNERS &
<br />MAC4259136
<br />$752,760 BUILDING
<br />CONTRACTORS
<br />$1,000 DEDUCTIBLE
<br />04/10/201504/10
<br />/2016
<br />$367,200 BPP - $300,000 BI WU. EE
<br />EQUIPMENT
<br />COV. INCL. THEFT
<br />$1116,318 SCHEDULED EQ.
<br />DESCRIPTION OF OPERATIONS d LOCATIONS I VEHICLES IACORD 161, Additional Remarks Schedule, may be attached if more space is required)
<br />THE CITY OF SANTA ANA, ITS DIRECTORS COMMISSIONERS, OFFICERS, EMPLOYEES, AGENTS, AND VOLUNTEERS ARE NAMED AS ADDITIONAL INSURED WITH
<br />RESPECTS TO THE ABOVE MENTIONED POLICIES PER ATTACHED ENDORSEMENT(S). COVERAGE IS PRIMARY & NON — CONTRIBUTORY AS REQUIRED BY
<br />WRITTEN CONTRACT, PER ATTACHED ENDORSEMENT FORMS. WAIVER OF SUBROGATION APPLIES, IF REQUIRED BY WRITTEN CONTRACT.
<br />. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF„ A 30 DAY WRITTEN NOTICE WILL BE ISSUED
<br />RE: PROJECT NAME: "SERVI�CE µ N MAINTENANCE MAINTENANCE AND .......... REPAIR
<br />SERVICES. "' CROSSTOWN JOB #2 --- T Q �„ �, -
<br />413 EN R ADVANCED TRAFFIC MANAGEMENT VN;TE -I1 SY SYSTEM D C UNICATI I� II({ l II „l I,:.I.)fl M (Ip'C,:a 101--10)
<br />is1 a all if id 07-171111 WE aILVA ■I NJ L11
<br />CITY OF SANTA ANA
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />20 CIVIC CENTER PLAZA M-36 THE EXPIRATION DATE THEREOF, NOTICE 'lIVlILL BE DELIVERED IN
<br />SANTA AN E, CA 92702 ACCORDANCE WITH THE POLICY PROVISIONS.
<br />AUTHORIZED REPRESENTATIVE
<br />1988 -2014 ACORD CORPORATION. All rights reserved..
<br />ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD
<br />
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