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ACOR" CERTIFICATE OF LIABILITY INSURANCE
<br />YYY)
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
<br />06/1
<br />06/14//2012017
<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 0757776 1-800-877-4560
<br />CONTACT
<br />HUB International Insurance Services Inc.
<br />NAME:
<br />PHONE FAX
<br />ZBF9201722 07
<br />g25 609-6500 925 609-6550
<br />A/C No Ext): A/C _ No):
<br />E-MAIL
<br />ADDRESS:
<br />P.O. Box 4047
<br />INSURERS) AFFORDING COVERAGE NAIC #
<br />Concord, CA 94524
<br />INSURERA: Citizens Insurance Company of America
<br />INSURED
<br />INSURERS: Navigators Specialty Insurance Company
<br />Harris & Associates Inc.
<br />Attn: Susan Mandilag
<br />INSURER C: Travelers Property Casualty Co of Amer.
<br />INSURER D: Continental Casualty Company
<br />1401 Willow Pass Road, Suite 500
<br />INSURER E:
<br />Concord, CA 94520
<br />INSURER F:
<br />COVERAGES CERTIFICATE NUMBER: 50101295 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 />ADDL
<br />SUBR
<br />POLICY NUMBER
<br />POLICY EFF
<br />MM/DD/YYYY
<br />POLICY EXP
<br />MM/DD/YYYY
<br />LIMITS
<br />A
<br />GENERAL LIABILITY
<br />ZBF9201722 07
<br />08/01/1
<br />08/01/17
<br />EACH OCCURRENCE $ 2,000,000
<br />X COMMERCIAL GENERAL LIABILITY
<br />DAMAGEPREMISESS ( RENTED Ea occurrence) $ 1,000,000
<br />MED EXP (Any one person)
<br />CLAIMS -MADE 1K OCCUR
<br />_$10,000
<br />PERSONAL & ADV INJURY $2,000,000
<br />X Ded: 0
<br />GENERAL AGGREGATE $4,000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />PRODUCTS - COMP/OP AGG $ 4,000,000
<br />POLICYFX_ PEO X LOC
<br />$
<br />AUTOMOBILE
<br />LIABILITY
<br />COMBINED SINGLE LIMIT
<br />Ea accident
<br />BODILY INJURY (Per person) $
<br />ANY AUTO
<br />ALL OWNED SCHEDULED
<br />AUTOS AUTOS
<br />BODILY INJURY (Per accident) $
<br />NON-OWNEDPROPERTY
<br />DAMAGE
<br />HIRED AUTOS AUTOS
<br />(Par.
<br />$
<br />B
<br />UMBRELLA LIAB
<br />X
<br />OCCUR
<br />LA16EXC712701IC
<br />08/01/1
<br />08/01/17
<br />EACH OCCURRENCE $ 10,000,000
<br />X
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />AGGREGATE $ 10, 000, 000
<br />DED X RETENTION $ 0
<br />$
<br />C
<br />WORKERS COMPENSATION
<br />PJUB8166N36A16 *
<br />08/01/1(708/01/17
<br />X WCSTATU- OTH-
<br />I ER
<br />AND EMPLOYERS' LIABILITY YIN
<br />E.L. EACH ACCIDENT $ 1,000,000
<br />ANY PROPRIETOR/PARTNER/EXECUTIVE
<br />OFFICER/MEMBER EXCLUDED? 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 $ 1,000,000
<br />D
<br />PROFESSIONAL LIABILITY
<br />AEH5 18915 8
<br />08 O1 1
<br />08/01/17
<br />Per Claim 5,000,000
<br />Claims -Made
<br />Aggregate 10,000,000
<br />Ded. Each Claim 150,000
<br />DESCRIPTION OF OPERATIONS / LOCATIONS/ VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required)
<br />* Workers Compensation policy excludes monopolistic states ND, OH, WA, WY.
<br />General Liability Additional Insured status granted, if required by written contract /agreement, per attached forms
<br />MAN -0426 0715 & MAN -0427 0715.
<br />REVIEWED BY: EUNICE HEREDIA (PG OFA )
<br />City, its officers, employees, agents & representatives are additional insureds under General Liability if required by
<br />written contract
<br />RE: On-call engineering services (A-2015-166) (HA #1401379)
<br />V CRI rrlI m I C nVL✓GR {.,/11Vl�GLLAIIVIV
<br />140-1379 (2 018)
<br />City of Santa Ana
<br />Leticia Lopez
<br />Public Works Agency
<br />20 Civic Center Plaza M-36
<br />Santa Ana, CA 92702
<br />ACORD 25 (2010/05)
<br />smandilag
<br />50101295
<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 � /I � ��/%j/
<br />USA q�AlE72E%1GC(/C�'Li---r
<br />U 1988-2010 ACORD CORPORATION. All rights reserved.
<br />The ACORD name and logo are registered marks of ACORD
<br />
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