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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 />