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ACCOR" CERTIFICATE OF LIABILITY INSURANCE
<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 />$/8/2017/DD/YYYY)
<br />THISSCCERTIFICATE 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 endorsements .
<br />PRODUCER
<br />CONTNAME: Certificate Department
<br />Cavignac & Associates
<br />450 B Street, Suite 1800
<br />PHONE FAX
<br />619 -744 0574
<br />_(ALGYNo.,_Ext619-234-8601
<br />p (A C No
<br />A AIcertificates@cavignac.com
<br />San Diego CA 92'101
<br />INSURER(S) AFFORDING COVERAGE NAIC #
<br />5/1/2018
<br />INSURER A: Liberty Insurance Corporation 42404
<br />INSURED NV51NCO-01
<br />_
<br />INSURER B: Travelers Property & Casualty Com a !125674
<br />CivilSource, Inc.
<br />INSURER C: Berkley Insurance Company 32603
<br />9890 Irvine Center Drive
<br />INSURERD:The First Liberty Insurance Corpora 33588
<br />Irvine, CA 92618
<br />—
<br />INSURER E:
<br />INSURER F:
<br />COVERAGES CERTIFICATE NUMBER: 1667747583 REVISION NtIMRFR-
<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 POLICIIUES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />INSR
<br />LTR
<br />TYPE OF INSURANCEIN
<br />ABIDEEFF
<br />SD
<br />SBIR
<br />WVD
<br />POLICY NUMBER
<br />MMIDDYIYYYYI
<br />POLICY EXP
<br />(MMIDDfYYYYI
<br />LIMITS
<br />B
<br />X COMMERCIAL GENERAL LIABILITY
<br />Y
<br />Y
<br />6809H706339
<br />5/1/2017
<br />5/1/2018
<br />EACH OCCURRENCE $1,000,000
<br />CLAIMS -MADE ❑X OCCUR
<br />DAMAGES( RENTED
<br />PREMISES Ea occurrence) $1,000,000
<br />MED EXP (Any one person) $10,000
<br />X Cross Liab/Sevin
<br />X 0 Deductible
<br />PERSONAL & ADV INJURY $1,000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />GENERAL AGGREGATE $2,000,000
<br />X POLICY PE 1XI LOC
<br />_
<br />PRODUCTS - COMP/OP AGG $2,000,000
<br />Stop Gap Liability $1,000,000
<br />OTHER:
<br />A
<br />AUTOMOBILE LIABILITY
<br />Y
<br />Y
<br />AS7Z91462442027
<br />5/1/2017
<br />5/1/2018
<br />COMBINED SINGLE LIMIT
<br />Ea accident $1,000,000
<br />X ANY AUTO
<br />BODILY INJURY (Per person) $
<br />AUTOWNED SCHEDULED
<br />'.. HIRED AUTOS NON -OWNED
<br />AUTOS
<br />BODILY INJURY (Per accident) $
<br />PROPERTY -DAMAGE $
<br />Per accident
<br />- $
<br />A
<br />X UMBRELLA LIAB
<br />X
<br />OCCUR
<br />TH7Z91462442037
<br />5/1/2017
<br />5/1/2018
<br />EACH OCCURRENCE $10,000,000
<br />AGGREGATE $10,000,000
<br />I EXCESS LIAB
<br />�I,
<br />CLAIMS -MADE
<br />DED X I RETENTION $0
<br />$
<br />D
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY Y / N
<br />y
<br />WC6Z91462442047
<br />5/1/2017
<br />5/1/2018PER
<br />OTH-
<br />X STATUTE ER
<br />E.L. EACH ACCIDENT $1,000,000
<br />ANY
<br />OFFICERPRIIMBOR/EXCLUDED?ECUTIVE N
<br />N/A
<br />E.L. DISEASE - EA EMPLOYEE $1,000,000
<br />(Mandatory in NH)
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE - POLICY LIMIT 1 $1,000,000
<br />C
<br />Professional Liability
<br />AEC901463201
<br />5/1/2017
<br />5/1/2018
<br />Each Claim $5,000,000
<br />Aggregate $10,000,000
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required)
<br />Re: A-2015-163 OnCall & A-2015-237 OnCall, A-2016-283, RFP #17-034 Construction Engineering -Walnut Pump Station Building upgrade
<br />and San Lorenzo Sewage Lift Station.
<br />Additional Insured coverage applies to General Liability and Automobile Liability for City of Santa Ana and their officers, agents and
<br />employees per policy form. Waiver of subrogation applies to General Liability, Automobile Liability, and Workers Compensation per policy
<br />form. If the insurance company elects to cancel or non -renew coverage for any reason other than nonpayment of premium Cavignac &
<br />Associates will provide 30 days notice of such cancellation or nonrenewal. Professional Liability�Claim ade form, defense costs included
<br />See Attached...
<br />REVIEWED BY: EUNICE HEREDIA (PC, ) OF )
<br />0104 1I Iiii l9]1 IME i RAJ Ak
<br />City of Santa Ana
<br />20 Civic Center Plaza
<br />Santa Ana CA 92701
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />AUTHORIZED REPRESENTATIVE
<br />ff� x�
<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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