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CONSO-2 OP ID: EB
<br />CERTIFICATE OF LIABILITY INSURANCE
<br />DATE 06/0 i1'2016Y}
<br />06/03/2016
<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 CER11FICATE 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 C7
<br />NAME:
<br />Butwin Insurance GroupEllen Begun
<br />PHONE _ FAX..-..-- -
<br />Suite 414 talc, Nq, gxr) 516.466-4200 Arc. Nor 516-466-4213
<br />60 Cutter Mill Road ADORess: ebe un butwin.com
<br />Great Neck, NY 11021-3104 —...
<br />Richard S. BLltwin INSURER(S) AFFORDING COVERAGE NAIC p
<br />_insuRERA:ZURICH INS CO j16535
<br />INSURED United Testing Corporation INSURER B: Travelers 41769
<br />dba United Inspection &
<br />Testing INSURERC Everest Indemnity Ins. Co. 10851
<br />— -- ----. .. _ .__..._
<br />22820 GOIdencrest Drive INSURER O:
<br />Suite 114 __..._..-------
<br />-; ----
<br />Moreno Valley, CA 92553 INSURER E:
<br />INSURER F
<br />COVFRAGFS CERTIFICATE NIIMRPP- RCVICInN Nn innar-0.
<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
<br />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.L —'—-------- t.... -POLICY EFF .-.' POLICY EXP
<br />LTR l TYPE OF INSURANCE INSD WVDPOLICY NUMBER MMIDO1YYYY I MMIDDIYYYY LIMITS
<br />COMMERCIAL GENERAL L
<br />LIABILITY �: l •! It
<br />J', LL
<br />1,000,000
<br />X GLO0381005 0710112016, 07/01/2017 ", r l : ; �, � „ f f
<br />--- -----------------
<br />500,000
<br />—
<br />10,000
<br />1,000,000
<br />2,000,000
<br />: X =
<br />21000,000
<br />---------
<br />AUTOMOBILE LIABILITY EIIE^i LE
<br />1,000,000
<br />A X X iBAPO361006 07/01/2016' 07/0112017
<br />—
<br />'.
<br />1
<br />X I UMBRELLA LIAB X -„-.- - -I ,. _ 1. E p_
<br />51000,000
<br />B EXCESS LIAB X ZUP91M34980-15 07101/2016 07/01/2017 E:aT_ i t
<br />5,000,000
<br />,
<br />F- i X --,JTi,- i is 10,000',
<br />WORKERS COMPENSATION =L=
<br />T
<br />AND EMPLOYERS LIABILTY X ...
<br />YiN
<br />A F I u� LF, t �_�rl i -�ruA WC0381004 07/01/2016 07101/2017 t, ,-I g
<br />1,000,000
<br />r - .. --
<br />I(Mandatory in NH)-
<br />_ _�c =- ac
<br />1,000,000
<br />1,000,000
<br />C Professional Liab PL5E000137-151 07/01/2016 07/0,112017 (Limit
<br />2,000,000
<br />Retro Date 9/1/85 Aggregate
<br />4,000,000
<br />DESCRIPTION OF OPERATIONS ( LOCATIONS 1 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 AND
<br />REPRESENTATIVES ARE NAMED AS ADDITIONAL INSUREDS WITH RESPECTS TO THE
<br />OPERATIONS PERFORMED BY OR ON BEHALF OF THE NAMED INUSRED, THIS INSURANCE IS
<br />PRIMARY AND NON CONTRIBUTORY WITH ANY OTHER INSURANCE CARRIED BY OR FOR'THE
<br />BENEFIT OF THE ADDITIONAL INSUREDS, 10 DAY NODI PAYMENT CANCELLATION APPLIES
<br />"RE-D1A
<br />RE.V9i` VAI .D BY V--, tLNBg, L tth PC
<br />09
<br />SANTAAN
<br />CITY of SANTA AA
<br />PUBLIC WORKS A ENCY' �p 0 2 l'6
<br />ROSS STREET ANNEX -M-
<br />20 CIVIC CENTER >:
<br />SANTA ANA, CA
<br />Lw_1\ w140111L11LwJwI
<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
<br />v trots-zu 14 rAl—umu uurr-umiA I Ivrv. Ali ngnfs reservea.
<br />ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD
<br />
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