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CERTIFICATE OF LIABILITY INSURANCE UATE(MM,DDIYYYY'
<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 />SELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING 1NSURER(SL AUTHORIZED
<br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
<br />IMPORTANT: if the certificate holder is an ADDITIONAL INSURED, the pollcygos) 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 confor rights to the
<br />certificate holder in lieu of such endDrsement(s).
<br />PRODUCER CONTACT
<br />ACT Risk Services Central, Inc. NAME: _
<br />Pittsburgh PA Offi Ce IA1CMa..Extl. (866j Ltl3712z___ aa,I, i900) 363-0105
<br />Dominion Power, 10th Floor EMAIL
<br />625 Liberty Avenue ADDRESS: _.._
<br />Pittsburgh PA 1.5222-3110 USA
<br />INSURERIS)AFFOROINE COVERAGE NAICq
<br />chaef Raker International, Inc.
<br />Box 57057
<br />vine CA 92619-7057 USA
<br />INS USSR IL
<br />INSURER C; National Lomas Fire ins co or PlttsDurgn 19ANS
<br />INSURER Er Lloyd's Syrldi Cate NO. 2623 AA1.128623
<br />THIS IS TO CERTIFY THAT TIIS 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 Oil MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED I'IEREIN IS SIIBJEC'f TO ALL THE TERMS,
<br />EXCLUSIONS AND CONDITIONS OP SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. Limits shown are as requested
<br />LTP...
<br />'SP
<br />TYPE OF INSURANCE
<br />RISC
<br />VNO
<br />POLICY NUMBER
<br />LAWS I y y
<br />DNYYYI P
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERA[. LIABILITY
<br />T62 1.004175 715
<br />D.
<br />EACHOCCURRENCE
<br />$2,000,000
<br />CLAIMS-M1IAOE IX �—I IOCC.VN
<br />I�
<br />UA 'TOIENTEO
<br />PNEM15ES(EBncrnrt+ancai
<br />$I00,OOD
<br />MED EXP{Anyone pereme
<br />ts, o00
<br />PERSONAL A ADV INJURY
<br />s2,000,000
<br />GLNI AGGRR.(MIE LIMIT APPLIES PER
<br />POLICY EPBO n LOC
<br />IEC1' �^
<br />IENERAI. AOGRLGAUR
<br />S4,000,000
<br />PRODUCTS. COMNOP AEG
<br />S!, 000.,000
<br />u;111:
<br />A
<br />AUTOMOBILE LIABILITY
<br />A.52-681-004145-725
<br />o8/30/201518,10,2111
<br />COMBINED SINGLE LIMIT
<br />fv awl ai4Y
<br />$1,00o,0oo
<br />BODILY INJURY (Pe, porn'at)
<br />X ANY AUTO
<br />BODILY INJURY Jr., occident)
<br />ALL OWNED SCHEDULED
<br />AUTOS AUTOS
<br />X HIREDAMOS X NOLLOWNED
<br />AUTOS
<br />PROPaRTY OAMAEE
<br />Pnr ocGldenn
<br />--m_-
<br />_i
<br />C
<br />x
<br />UMORELLALIAB
<br />X
<br />OCCUR
<br />DE033086983
<br />08/3012015
<br />08/3012016
<br />EACH OCCURRENCE
<br />$1010001000
<br />F&n[SRLIAR
<br />ULAIMSMADL
<br />AGGREGATE
<br />$1.01000,000
<br />DIED I X RETENTION 110,000
<br />9
<br />B
<br />WORKERS COMPENSATION AND
<br />EMPLOYERS LIABILRY YIN
<br />ANY PROPRIITDR I PARTNER I FSCUTIVE
<br />aFnCMVMLMnfiIt EXCLU CED" ��
<br />tenndMary In Hui
<br />If mY. '33e,LS ar,dar
<br />1) FI ION CI- OPERA( ONS DIAb
<br />NIA
<br />1VA7 B00 14 7 :
<br />ADS
<br />Wc768100-01457a3
<br />WI
<br />0 20 5
<br />U9130/2 Ufa
<br />8 'c :6
<br />ORJ3UJ2U16
<br />PER Orfl.
<br />X STATVf ER
<br />. EACH ACC ID EN I'
<br />kLILI)
<br />�s1,000,000
<br />e.L. DMEASL.EAEMPLOYrE
<br />L.L. DISEAEEPOLOY LIMIT
<br />$1,000,000
<br />s110001000
<br />o
<br />E&O-PL-Primary
<br />QC15D2675
<br />08/31/2013
<br />08/31/201C
<br />Per Claim
<br />$5,0001000
<br />Professional &Pollution
<br />Aggregate
<br />$510DO.000
<br />SIR dpplies Per policy tar
<br />; & condl
<br />ions
<br />DESCRIPTION OF OPERATIONS LOCATIONS I VEHICLE 9(ACORD 101, AWmnoal Ramerkf Selmduio, may be aYWcbod V moan, epneo Is mg firom
<br />For Named Insured Only: Attn: Kim Hartsfield. RE: on -Call Engineering Eorvicos., A-2013-014-01 anti A-2015-000,: RFP No.
<br />14-037, City of Santa Are, its officers, employees agents and representatives are included Be Additional insured in
<br />accordance with the policy provisions of the Generai Liability policy. General Liability policy evidenced herein is Primary
<br />and Non-contributory to other insurance available to an Additional Insured, but only in accordance with the policy's
<br />provisions. Should General Liability, AUtOmObile Liability and workers' compensation policies be cancelled Before the
<br />expiration date there of, the policyprovisions Will govern how notice of cancellation may be delivered to certificate holders
<br />in accordance with the policy provisions.
<br />M
<br />CERTIFICATE HOLDER
<br />CANCELLATIONr_'.3
<br />SHOULD ANY OP THE ABOVE DESCRIBED POLICIES VE BE CANCELLED BEFORE THE
<br />CARNATION DATE THEREOF, NOTICE WILL RE DELIVERED IN ACCORDANCE WEIt THE
<br />rd
<br />y}
<br />POLICY PROVISIONS,
<br />PRO
<br />City of Santa Are
<br />AUT130RIZED REPRESENTATIVE
<br />20 civic Center Plaza (M-30)
<br />Po Box 1988
<br />Santa Ara. CA 92702-1988 USA
<br />rb i�ViBLd9C�'90 .i''7�i2crZG9'zGl.
<br />m1088.2014 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD
<br />
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