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CI ient#: 25483
<br />POWEENG11
<br />ACOR®TM CERTIFICATE OF LIABILITY INSURANCE
<br />DATE (MM/DD/YYYY)
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
<br />5/18/2016
<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
<br />NAMEACT Jerry Noyola
<br />Greyling Ins. Brokerage/EPIC
<br />PHONE FAx
<br />A/c, No, Ext): 770-552-4225 A/c No ; 866-550-4082
<br />3780 Mansell Road, Suite 370
<br />E-MAIL
<br />ADDRESS:_ jerry.noyola@greyling.com
<br />Alpharetta, GA 30022
<br />04/01/2017
<br />877 908-5619INSURERS)
<br />AFFORDING COVERAGE NAIC If
<br />INSURER A: National Union Fire Ins. Co. 19445
<br />INSURED
<br />INSURER B: New Hampshire Insurance Co. 23841
<br />POWER Engineers, Inc.
<br />IN C: Syndicate 11 2623/62 11 3 at Lloyd's
<br />3940 Glenbrook Drive; P.O. Box 1066
<br />Hailey, ID 83333
<br />INSURER D
<br />INSURER E
<br />INSURER F:
<br />COVERAGES CERTIFICATE NUMBER: 16-17 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 CONTRACTOR 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 />INSR
<br />SUBR
<br />WVD
<br />POLICY NUMBER
<br />POLICY EFF
<br />MM/DD/YYYY
<br />POLICY EXP
<br />MM/DD/YYYV
<br />LIMITS
<br />A
<br />X.' COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE X OCCUR
<br />5268183
<br />4/01/2016
<br />04/01/2017
<br />EACH OCCURRENCE $1,000,000
<br />DAMAGE 7O RENTED
<br />PREMISES Eaoccurrence $500000
<br />MED EXP (Any one person) s25,000
<br />X Contractual Liab.
<br />PERSONAL & ADV INJURY $1,000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />POLICY I......^I JECOT � LOC
<br />GENERAL AGGREGATE $ 2,000,000
<br />PRODUCTS - COMP/OPAGG $2,000,000
<br />$
<br />',... OTHER:
<br />A
<br />AUTOMOBILE LIABILITY
<br />4489679 (ADS)
<br />4/01/2016
<br />04/01/2017
<br />EO BINEDISINGLELIMIT 1,000,000
<br />BODILY INJURY (Per person) $
<br />XANY AUTO
<br />A
<br />'.. ALL OWNED SCHEDULED AUTOS AUTOS
<br />'.
<br />X HIRED AUTOS X_._ NON -OWNED
<br />AUTOS
<br />() 4489678 MA
<br />04/01/2016
<br />04/01/2017
<br />BODILY INJURY (Per accident) $
<br />PROPERTY DAMAGE $
<br />Per accident
<br />UMBRELLA LIAB OCCUR
<br />EACH OCCURRENCE $
<br />AGGREGATE $
<br />EXCESS LIAB CLAIMS -MADE
<br />$
<br />DED RETENTION $
<br />B
<br />A
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY Y / N
<br />ANY PROPRIETOR/PARTNER/EXECUTIVEE.L.
<br />OFFICER/MEMBER EXCLUDED? �
<br />(Mandatory in NH)
<br />N / A
<br />15893717 (AOS)
<br />15893718 (CA)
<br />4/01/2016
<br />4/01/2016
<br />04/01/201
<br />04/01/2017
<br />X PEARLITE OTH-
<br />EACH ACCIDENT $1000,000
<br />s,
<br />E.L. DISEASE - EA EMPLOYEE $1,000,000
<br />_
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE - POLICY LIMIT $1,000,000
<br />C
<br />Professional LiabW13B97160401
<br />4/01/2016
<br />04/01/201
<br />Per Claim $5,000,000
<br />Aggregate $5,000,000
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
<br />The City of Santa Ana, its officers, employees, agents, volunteers & representatives are named as
<br />Additional Insureds on the above referenced liability policies with the exception of workers compensation &
<br />professional liability where required by written contract. The above referenced liability policies with the
<br />exception of professional liability are primary & non-contributory where required by written contract.
<br />Should an of the above described policies be cancelled b the issuingInsurer�before efe P
<br />See Attached Descriptions)P y ✓ir tton a �IW�NI� H FIS I �'�iA (PP o1-
<br />10"Ri■111IR10"111111311111L.l, laP
<br />City of Santa Ana SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />20 Civic Center Plaza ACCORDANCE WITH THE POLICY PROVISIONS.
<br />Santa Ana, CA 92701
<br />AUTHORIZED REPRESENTATIVE
<br />©1988-2014 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2014/01) 1 of 2 The ACORD name and logo are registered marks of ACORD
<br />#S487570/M465481 JNOY1
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