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CONSO-2 OP ID: EB
<br />ACRO CERTIFICATE OF LIABILITY INSURANCE
<br />DATE(MMlOOMYVY)
<br />11512612016
<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(les) 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 />Butwln insurance Group
<br />Suite 414
<br />ll Road
<br />Great Nock,NY 99021.3900.
<br />CONTACT Ell en Begun
<br />PHONEFAc No! 516366-021 3
<br />ADDss:y
<br />--
<br />INSURER(S)AFFORDING COVERAGE NAICN
<br />RlchardS.Butwin
<br />INSURER A: ZURICH INS CO 16535
<br />GL00381005
<br />INSURED UnitedTesting Corporation
<br />aUnitedInspectionS
<br />Testing
<br />INSURERS: TraVelerS 41769
<br />INsuRERG:Everest Indemnity Ins. Co. 10951
<br />D:
<br />22820 Goldencrost DriveINSURER
<br />Suite 914
<br />INSURER E:
<br />Moreno Valley, CA 92553
<br />INSURER F:
<br />L;VVEKAGES CERTIFICATE NUMBER: REVISION NUMBER'
<br />THIS IS TO CERTIFYTHAT 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 MAYHAVE BEEN REDUCED BY PAID CLAIMS.
<br />/CTR
<br />TYPE OF INSURANCE
<br />ADM
<br />INSD
<br />=1
<br />POLICY NUMBER
<br />POLICY EFF
<br />MMIDO
<br />MMIL0100m)
<br />LIMITS
<br />A
<br />X COMMERCIAL GENERAL LIABILITY
<br />CLAIMS.MADE ® OCCUR
<br />X
<br />X
<br />GL00381005
<br />07/01/2015
<br />07/01/2016
<br />EACH OCCURRENCE $ 1,000,000
<br />PREMISESEeoccu e e S 500,00
<br />MED EXP(Any one person) 8 10,000
<br />PERSONAL B ADV INJURY $ 1,000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />POLICY a JECT LOC
<br />GENERAL AGGREGATE $ 2,000,000
<br />PRODUCTS. COMPIOP AGG $ 2,000,000
<br />$
<br />OTHER:
<br />AUTOMOBILE
<br />LIABILITY
<br />Ea eBNED SINGLE LIMIT $ 1,000,00
<br />A
<br />X
<br />ANY AUTO
<br />X
<br />X
<br />BAP0381006
<br />07101/2015
<br />07101/2016
<br />BODILY INJURY (Per parson) $
<br />ALLOY/NEDLEO
<br />AUTOS
<br />AUTOS AUTOS
<br />HIRED AUTOS NON -OWNED
<br />AUTOS
<br />BODILY INJURY Per accident) $
<br />PROPERTY DAMAGE $
<br />Per accident
<br />$
<br />X
<br />UMBRELLA LIAB
<br />X
<br />OCCUR
<br />EACH OCCURRENCE $ 5,000,00
<br />g
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />UPg1M34980.15
<br />07/01/2015
<br />07/0112016
<br />AGGREGATE $ 5,000,00
<br />DEO I X I RETENTION$ 10,006
<br />$
<br />A
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY
<br />ANY PROPRIETORIPARTNERIEXECU7IVE YIN
<br />OFFICERIMEMBER EXCLUDED?
<br />(Mandatory in NH)
<br />It yes desaft under
<br />DESCRIPTION OF OPERATIONS below
<br />NIA
<br />X
<br />WC0381004
<br />07101/2015
<br />07/01/2016
<br />X STATUTE ER
<br />E.L. EACH ACCIDENT $ 1,000,000
<br />E.L. DISEASE EA EMPLOYEE S 1,000,000
<br />E.L. DISEASE. POLICY LIMIT $ 1,000,000
<br />C
<br />Professional Llab
<br />PL5E000137.151
<br />07/01/2015
<br />07/01/2016
<br />Limit 2,000,000
<br />Retro Date 911/85
<br />Aggregate 4,000,00
<br />DESCRIPTIONOF OPERATIONS I LOCATIONGIVEHICLES (ACORD 10/,Additional Remarks Schedule, maybe attached 11 more apace is required)
<br />City of Santa Ana, its officers, employees, agents, volunteers and
<br />representatives, is an additional insured, on a primary non contributory
<br />osis. There is a 30 day cancellation clause on the policies
<br />1 operations '�
<br />RFP15-055 Geotechnical, special inspection & meterial testing service
<br />REVIEWED BY:�ji y EUNICE HEREDIA(PG QOF,
<br />CERTIFICATE HOLDER CANCELLATION
<br />CITYSAA
<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 />20 Civic Center Plaza
<br />-----
<br />AUTHORIZED REPRESENTATIVE
<br />Santa Ana, CA 92702
<br />O 1988.2014 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD
<br />
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