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A� ®® CERTIFICATE OF LIABILITY INSURANCE
<br />DAT6 /22/2015 Y)
<br />06/22/2015
<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 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 LICENSE NO. 0637431
<br />NAME: PATRICK MCRAE
<br />PATRICK MCRAE INSURANCE SERVICES
<br />1290 N. HANCOCK ST., SUITE 210
<br />Ext, (714) 779 -6999 ap No, (714) 779 -6903
<br />Rest),
<br />nooaess: p.mcrae @sbcglobal.net
<br />INSURERS AFFORDING COVERAGE
<br />NAIL#
<br />ANAHEIM HILLS, CA 92807
<br />INSURERA: BURLINGTON INSURANCE COMPANY
<br />23620
<br />/2016
<br />INSURED
<br />INSURERS: INSURANCE COMPANY OF THE WEST
<br />27847
<br />DAVID HEERMANCE
<br />INSURER C: CENTURY - NATIONAL INSURANCE CO.
<br />26905
<br />CROSSTOWN ELECTRICAL & DATA, INC.
<br />5463 DIAZ STREET #525910867
<br />IRWINDALE CA 91706
<br />INSURERD: GREAT AMERICAN INS CO OF NY
<br />22136
<br />INSURERE: GREAT AMERICAN INSURANCE COMPANY
<br />16691
<br />INSURER F:
<br />X
<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 />INSR
<br />LTR
<br />TYPE OF INSURANCE
<br />ADDLSUBR
<br />INSD
<br />WVD
<br />POLICY NUMBER
<br />POLICY EFF
<br />MM /DDIYYYY
<br />POLICY EXP
<br />MMIDDNYYY
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />X
<br />X
<br />HGL0041516
<br />06/03/201506/03
<br />/2016
<br />EACH OCCURRENCE
<br />IS 1,000,000
<br />CLAIMS -MADE OCCUR
<br />XCU
<br />DEDUCTIBLE:
<br />$5,000 PER OCC
<br />RENTED
<br />PREA SES Ea occurrence
<br />$ 50,000
<br />X
<br />MED EXP (Any one person)
<br />$ 5,000
<br />X
<br />OCP
<br />PERSONAL& ADV INJURY
<br />$ 1,000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER',
<br />GENERAL AGGREGATE
<br />$ 2,000,000
<br />POLICY JEST 1-1 LOG
<br />PRODUCTS -COMPIOPAGG
<br />$ 2,000,000
<br />$
<br />OTHER:
<br />C
<br />AUTOMOBILE
<br />LIABILITY
<br />ANY AUTO
<br />AUTOSNED X AUTOSULED
<br />HIRED AUTOS X NON -OWNED
<br />AUTOS
<br />X
<br />BAP0171987
<br />COMPREHENSIVE DED.
<br />$1,000
<br />COLLISION DED.
<br />$1,000
<br />11/05/201411/05
<br />/2015
<br />COMBINED SINGLE UMIT
<br />Ea acc,dent
<br />$ 1,000,000
<br />BODILY INJURY Per person)
<br />( P )
<br />$ -
<br />Ix
<br />BODILY INJURY(Per accdent)
<br />$
<br />PROPERTY DAMAGE
<br />Per accident
<br />$
<br />$
<br />E
<br />UMBRELLALIAB
<br />X
<br />OCCUR
<br />TUE429515200
<br />06/03/201506/03
<br />/2016
<br />EACH OCCURRENCE
<br />$ 10,000,000
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />UNDERLYING LIMITS:
<br />GL; AL; EL POLICIES
<br />X
<br />AGGREGATE
<br />$ 10,000,000
<br />X
<br />BED I I RETENTION$ 0
<br />_
<br />$ -
<br />B
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY
<br />ANY PROPRIETOR/PARTNEWEXECUTIVE YIN
<br />OFFICER /MEMBEREXCLUDED? �
<br />(MandatoryinNH)
<br />NIA
<br />x
<br />WLV503035400
<br />06/03/201506/03
<br />/2016
<br />X I SEATUTE 6RH
<br />E.L. EACH ACCIDENT
<br />$ 1,000,000
<br />E.L. DISEASE - EA EMPLOYEE
<br />—
<br />$ 1,000,000
<br />DE SCRIPTION OF OPERATIONS below
<br />E.L. DISEASE - POLICY LIMIT
<br />$ 1,000,004
<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 WI EE
<br />EQUIPMENT
<br />COV. INCL. THEFT
<br />$116,318 SCHEDULED EQ.
<br />DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
<br />THE CITY OF SANTA ANA, ITS DIRECTORS, COM ISSIONERS, 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: "SERVICE AGREEMENT FOR ADVANCED TRAFFIC MANAGEMENT SYSTEM AND COMMUNICATION MAINTENANCE AND REPAIR SERVICES"
<br />CROSSTOWN JOB #2413
<br />CERTIFICATE HOLDER CANCELLATION
<br />CITY OF SANTA ANA
<br />20 CIVIC CENTER PLAZA M -36
<br />ANY OF
<br />EXPIRATIIONH DATE DESCRIBED VTHEREOF, NOTIICEI WILL BE
<br />THE SHOULD
<br />CBE CDELIVERED BEFORE
<br />IN
<br />SANTA ANA, CA 92702
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />,ROSSTOWN EL CTRICAL & DATA A- 2012 -177 & EXTENSION REVIEWED B
<br />AUTHORIZED REPRESENTATIVE
<br />EUNICE HEREDIA (PG 1 OF 10)
<br />@ 1988.2013 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2013/04) The ACORD name and logo are registered marks of ACORD
<br />
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