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<br />CERTIFICATEF LIABILITY INSURANCE111212015
<br />ATE(MMIDD/YYYYI
<br />r
<br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.. THIS
<br />CERTIFICATE DOES INOT 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 endorsoment(s).
<br />PRODUCER
<br />Ann Risk Services Central, Inc.
<br />Pittsburgh PA office
<br />CONTACT
<br />NAME:
<br />PHONE (866) 283-7122 FAX (800) 361-0105
<br />(A/C. No. Ext): (AfC.. No.:.
<br />E;-MAIL
<br />ADDRESS:
<br />Domin"ions Tower„ loth Floor
<br />625 Liberty Avenue
<br />INSURER(5) AFFORDING COVERAGE
<br />NAIL #
<br />Pittsburgh PA I522.2-3110 USA
<br />INSURED
<br />INSURER A: Liberty Mutual Fire Ins Co
<br />23035
<br />Michael Baker I:nternat-ional, Inc.
<br />P() Box 57057
<br />Irvine CA 92619-7057 USA
<br />INSURERB: Liberty Insurance Corporation
<br />42404
<br />INSURERC: National union Fire Ins co of Pittsburgh
<br />19445
<br />INSURERD: Lloyd's Syndicate No. 2623
<br />AA1128623
<br />INSURER E:
<br />INSURER F: ,
<br />COVERAGES CERTIFICATE NUMBER: 570060247650 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. Limits shown are as requested
<br />...LIMITS
<br />LTR
<br />TYPE. OF INSURANCE.
<br />INSO
<br />WV'D
<br />POLICY NUMBER
<br />MMIDDIYYYY
<br />MMIDDIYYYY
<br />A
<br />X
<br />COMMER'CIAL. GENERAL LIABILITY
<br />TiS268
<br />EACH 9CCURR,ENCE
<br />$2 , 000 , 000
<br />CLAIMS -MADE � OCCUR
<br />DAMAGE O RIEN.. ., U
<br />PREMISES Ea occurrence)
<br />$100, 000
<br />X
<br />MED EXP (Any ou e persony
<br />s s , 000
<br />Contractual Liability
<br />PERSONAL A ADVINJURY
<br />$2 , 000 , 000
<br />GEN'L. AGGREGATE LIMIT APPLIES PER.
<br />GENERAL AGGREGATE
<br />$4 , 000 , 000
<br />POLICY � PRO- � LOC
<br />JIECT
<br />PRODUCTS - COMP',IOP .AGO
<br />S4,000,000
<br />OTHER:
<br />A
<br />AUTOMOBILE. LIABILITY
<br />A52-681-004145-725
<br />08/30/201.5
<br />0.,8/30/2016
<br />COMBINED SINGLE LIMIT
<br />Ea accident)
<br />$1,000,000
<br />BODILY INJURY ( Pec person)
<br />X ANY AUTO
<br />BODILY INJURY (Peraccident),
<br />EDULED
<br />ALL. OWNEDTAUTOS
<br />AUTOS TOS
<br />X HIRED AUTOS NON -OWNED
<br />RRCPERTY DAMAGE
<br />Per accidenll
<br />C
<br />X
<br />UMBRELLA LIAR
<br />X
<br />OCCUR
<br />BED33086983...
<br />08/30/201.5
<br />O8/30/2016
<br />EACH OCCURRENCE
<br />$10,000,000
<br />EXCESS LIAR
<br />CLAIMS -MADE
<br />AGGREGATE
<br />$10,000, 000
<br />DED I X RETENTION SID, 000
<br />B
<br />B
<br />WORKERS COMPENSATION AND
<br />EMPLOYERS' LIABILITY Y 1 N
<br />ANY PROPRbETCR f PARTNIER f Ex.ECUTIVE
<br />OFFICERtMEMBEREXCLLJDED?
<br />(Mandatory in NH)
<br />N1A
<br />WWA768DO04145775
<br />AIDS
<br />WC7681004145785
<br />Wk
<br />08/30/2015
<br />08/30/2015
<br />09/30/2016
<br />08/30/2016
<br />x Sf.4'1'UTE. ERH
<br />E.L. EACH ACCIDENT
<br />$1 , 000, 000
<br />E.L. DISEASE -EA EMPLOYEE
<br />$1, 000, 000
<br />9 Yes describe under'
<br />DESCRIPTION OF OPERATIONS below
<br />E L. DISEASE -POLICY LIMIT
<br />$1„000, 000
<br />D
<br />E&C-PL-Primary
<br />r1C1502675
<br />08131/2015
<br />09/31/2016
<br />Per Claim
<br />S5,000,0p0
<br />Professional & Pollution
<br />Aggregate
<br />$5,000,00o
<br />SIR applies per policy terns
<br />& condi
<br />ions
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES IACORD 101, Additional Remarks Schedule, may be attached it more space is required)
<br />For Named Insured only: Attn: Kim Hartsfield, RE'.: on -call 'Engineering Services, A-2013-014-01 and A-2015-170, RFP No.
<br />14-037. city of Santa Ana, its officers, employees, agents and representatives are included as Additional insured in
<br />accordance with the policy provisions of the General 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 policy provisions will govern how notice of cancellation may be delivered to certificate holders
<br />in accordance with the policy provisions.
<br />CERTIFICATE HOLDER
<br />CANCELLATION'
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
<br />EXPIRATION DATE THEREOF, NOTICE WILL BE
<br />DELIVERED IN ACCORDANCE WITH THE
<br />POLICY PROVISIONS.
<br />City of Santa Ana
<br />20 CiviC Centel" Plaza (M-30)
<br />AUTHORIZED REPRESENTATIVE
<br />PO Box 1988
<br />Santa Ana CA 92.702-1988 USA
<br />@198872014 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2014/01) The ACORD name and logo are registered marlc5 of ACORD
<br />Fll=:Vlt_/VLD BY: � r �. I-:I..IIWWiCE HE RIE )IA (PG I OF "")...
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