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AIc"R& CERTIFICATE OF LIABILITY INSURANCE
<br />�.....-1
<br />DATE(MMiDDNYYY)
<br />11/13/2015
<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 INSU'RER(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 I5 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 />Greyling Insurance Brokerage
<br />3780 Mansell Road
<br />Suite 370
<br />Alpharetta GA 30022
<br />CONTACT.. No ola
<br />NAME: Y Y
<br />PHONE (770)552-4225 41C Na:AX (866)556--4082
<br />E-MAIM na o1a@ re lin
<br />ADDRESS:Jerry • Y g Y g. com
<br />INSURER S ) AFFORDING COVERAGE
<br />NAIL td
<br />INSURERA;National Union Fire Ins Co
<br />19445
<br />INSURED
<br />P s oa s
<br />555 S . Flower Street
<br />Suite 4300
<br />Los Angeles C.A. 90071
<br />INSURER B
<br />INSURER C
<br />INSURER D
<br />IN'...SURER E:
<br />INSURER F:
<br />COVERAGES CERTIFICATE NUMBER-15-16 REVISION NtIMBPR'.
<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 />PNSR
<br />LTR
<br />TYPE OF INSURANCE
<br />ADDL
<br />SUBR
<br />POLICY NUMBER
<br />POLICY EFF
<br />IMM DDNYYY
<br />POLICY EXP
<br />MMIDDJIYYYI
<br />OMITS
<br />GENERAL LIABILITY
<br />EACH OCCURRENCE
<br />$ 1 , 000, 000
<br />A
<br />COMMERCIAL GENERAL
<br />CLAIMS -MADE OCCUR
<br />047634
<br />4/1/2015
<br />4/1/2016MED
<br />MA
<br />T.
<br />PREMEy
<br />�X
<br />$ , 000
<br />FXP (Any one ..
<br />.._5
<br />$ 25,000
<br />PERSONAL 8 ADV INJURY
<br />....
<br />S 1,000,000
<br />X Contractual Liability
<br />GENERAL AGGREGATE
<br />$ 2,000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER
<br />PRODUCTS - COMP/OP AGG
<br />'. $ 2,000,000
<br />POLICY X PRO-JECT i{ LOC
<br />AUTOMOBILE
<br />LIABILITY
<br />COMBINED SINGLE LIMIT
<br />(Ea accident)
<br />1,000,000
<br />X
<br />BODILY INJURY (Per per
<br />$
<br />A
<br />ANY AUTO
<br />ALL OWNED SCHEDULED
<br />AUTOS AUTOS
<br />3814893
<br />4/1/2015
<br />4✓1/2016
<br />BODILY INJURY (Per accident)
<br />..
<br />$
<br />X
<br />NON -OWNED
<br />X HIRED AUTOS AUTOS
<br />PROPERTY DAMAGE
<br />$
<br />r.Peraccident)
<br />$
<br />UMBRELLA LI�AB
<br />UR
<br />EACH OCCURRENCE
<br />$
<br />FLILICIMS-MAD�E
<br />AGGREGATE.
<br />$
<br />EXCESS LIAR
<br />OED I I RETENTION$
<br />$
<br />A
<br />A
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY YIN
<br />ANY PROPRIETORIPARTNE.R/EXECUTIIVE
<br />DFFICERAJEMBER EXCLUDED" �
<br />(Mandatory inNHl
<br />NPA
<br />39901498 (ADS)
<br />39901499 (CA)
<br />4/1/2015
<br />4/1/2015
<br />4/1/2016
<br />4/1/2016
<br />WC STATU- OTH -
<br />,TORY LIMrp
<br />E.L. EACH ACCIDENT
<br />...
<br />$ 11000,000
<br />E.L. DISEASE-EAFMPLOYE'$
<br />._
<br />11000,000
<br />If yes, describe under
<br />"—
<br />DFSCRIPTION OF OPERATIONS helow
<br />E.L. DISEASE - POLICY LIMIT
<br />'... '$ 1,000,000
<br />i
<br />_ -..
<br />DESCRIPTION OF OPERATIONS I LOCATIONS C VEHICLES (Attach ACORD 181, Additional Remarks Schedule, if more space is required)2SAN051100,
<br />Agreement NOS, A-2008-219 & A-2015-167, City of Santa Ana. On —Cali Engineering Services
<br />14-037. The City of Santa Ana (20 Civic Center Plaza, Santa Ana, California 92701) it officers,
<br />employees, agents & representative are named as Additional Insureds with respects to General & Automobile
<br />Liability where required by written contract. The above referenced liability policies are, primary &
<br />non-contributory where required by written contract. Separation of Insureds applies to the General
<br />Liability Policy. Should any of the above described policies be cancelled by the issuing insurer before
<br />the expiration date thereof, 30 days' written notice (except 10 days for nonpayment of premium) will be
<br />CERTIFICATE HOLDER CANCELLATION
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />City of Santa Ana
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />PWA—Design Engineering
<br />AUTHORIZED REPRESENTATIVE
<br />Monica M . Suter, PE, "lTE , PTOE
<br />20 Civic Center Plaza, M-36
<br />Santa Ana, CA 92702
<br />David Colli.ngs!"JERRY
<br />ACORD 25 (2010105)
<br />N Srb2.ri Ian nnSl ni
<br />@ 1988-20�10 ACORD CORPORATION. All rights reserved.
<br />Tl+a Af`r1Rll mama nnrt Innn mra ra+niatcarr,rl —i— nff ar npn
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