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AC"RV CERTIFICATE OF LIABILITY INSURANCE
<br />PATE (MM/DD/YYYY)
<br />11/03/2016
<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 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 LICENSE NO. 0637431
<br />PATRICK MCRAE INSURANCE SERVICES
<br />1290 N. HANCOCK ST., SUITE 210
<br />ANAHEIM HILLS, CA 92807
<br />CONTACT NAME: PATRICK MCRAE
<br />PHONE# -FAx 4
<br />779-6903 -
<br />IA/C,-No-E: (714 - 779-6999 ._..._ .................-----—�A/C,. No): (714)
<br />----------....
<br />E-MAILADDRESS: p.mcrae@sbcglobal.net
<br />INSURER(S)AFFORDINGCOVERAGE
<br />-- —
<br />NAIC#
<br />- - -
<br />COLONY INSURANCE COMPANY
<br />39993
<br />103 GL 0014267-00
<br />DEDUCTIBLE $5,000 PER
<br />OCCURENCE
<br />INSURED
<br />_iNSURERA:
<br />INSURERB: INSURANCE COMPANY OF THE WEST
<br />27847
<br />CROSSTOWN ELECTRICAL & DATA, INC.
<br />5463 DIAZ STREET
<br />IRWINDALE CA 91706
<br />INSURERC:CENTURY-NATIONAL INSURANCE CO.
<br />26905
<br />INSURERD: TOPA INSURANCE COMPANY
<br />18034
<br />INSURER E: TOKIO MARINE SPECIALTY INSURANCE CO
<br />23850
<br />INSURER F:
<br />OCP _ _
<br />COVERAGES CERTIFICATE NUMBER: 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.
<br />INSR
<br />LTR
<br />TYPE OF INSURANCE
<br />ADDL
<br />SUBR
<br />POLICY NUMBER
<br />POLICY EFF
<br />MM/DD/YYYY
<br />POLICY EXP
<br />( MMIDD/YYYY
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE � OCCUR
<br />XCU
<br />X
<br />X
<br />103 GL 0014267-00
<br />DEDUCTIBLE $5,000 PER
<br />OCCURENCE
<br />06/03/2016
<br />(
<br />06/03/2017
<br />EACH OCCURRENCE
<br />Is 1,000,000
<br />��
<br />DAMAGE TO RENTED
<br />PREMISES Ea occurrence
<br />$ 100,000
<br />X
<br />MED EXP (Any one person)
<br />$ 5,000
<br />LX
<br />OCP _ _
<br />PERSONAL & ADV INJURY
<br />$ 1,000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER:GENERAL
<br />POLICY 7 PEO- LOC
<br />HOTHER:
<br />AGGREGATE
<br />$ 2,000,000
<br />PRODUCTS-COMP/OPAGG
<br />............. —
<br />$ 2,000,000
<br />— —
<br />--
<br />$
<br />C
<br />AUTOMOBILE
<br />LIABILITY
<br />X
<br />X
<br />BAP0171987
<br />1 1 /05/2016
<br />1 1 /05/2017
<br />COMBINED SINGLE LIMIT
<br />$ 1,000,000
<br />X
<br />ANY AUTO
<br />BODILY INJURY (Per person)
<br />$
<br />X
<br />ALL OWNED XSCHEDULED
<br />AUTOS AUTOS
<br />NON -OWNED
<br />HIRED AUTOS , X._ AUTOS
<br />(Per accident BODILY LY INJURY
<br />$
<br />_)
<br />PROPERTY DAMAGE
<br />Per accident)$
<br />-
<br />E
<br />X
<br />rX
<br />� X �
<br />UMBRELLA LIAB X OCCUR
<br />EXCESS LIAB CLAIMS -MADE
<br />DED -
<br />DI RETENTION $ 0
<br />PUB542883
<br />UNDERLYING LIMITS:
<br />GL; AL; EL POLICIES
<br />06/03/2016
<br />06/03/2017
<br />EACH OCCURRENCE
<br />$ 10,000,000
<br />AGGREGATE
<br />$ 10,000,000
<br />-
<br />$ -
<br />B
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY Y / N
<br />ANY PRO PRIETOR/PARTNER/EXECUTIVEE.L.
<br />OFFICER/MEMBER EXCLUDE❑Y
<br />D?
<br />(Mandatory in NH)
<br />If yes, describe under---
<br />DESCRIPTION OF OPERATIONS below
<br />N I A
<br />x
<br />WVE 5030354-01
<br />06/03/2016
<br />06/03/2017
<br />X I STATUTE ERH-
<br />—
<br />EACH ACCIDENT
<br />$ 1,000,000
<br />E.L. DISEASE - EA EMPLOYEE
<br />$ 1,000,000 _
<br />E.L. DISEASE - POLICY LIMIT
<br />—
<br />$ 1,000,000
<br />D
<br />PROPERTY &
<br />PC 6600295
<br />$790,849 BUILDING
<br />CONTRACTORS
<br />$1,000 DEDUCTIBLE
<br />04/10/2016
<br />04/10/2017
<br />$385,780 BPP - $300,000 BI WI EE
<br />$116,318 SCHEDULED EQ.
<br />EQUIPMENT
<br />COV. INCL. THEFT
<br />$50,000 MISCELLANEOUS TOOLS
<br />DESCRIPTION OF OPERATIONS / LOCATIONS /VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required)
<br />THE CITY OF SANTA ANA, ITS DIRECTORS, COMMISSIONERS, OFFICERS, EMPLOYEES, AGENTS, AND VOLUNTEERS , ARE NAMED AS ADDITIONAL INSURED WITH
<br />RESPECTS TO THE ABOVE MENTIONED POLICIES PER ATTACHED ENDORSEMENT(S). COVERAGE IS PRIMARY & NON-CONTRIBUTORY AS REQUIRED BY
<br />WRITTEN CONTRACT, PER ATTACHED ENDORSEMENT FORMS. WAIVER OF SUBROGATION APPLIES, IF REQUIRED BY WRITTEN CONTRACT,
<br />* SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, A 30 DAY WRITTEN NOTICE WILL BE ISSUED,
<br />RE: PROJECT NAME: "SERVICE AGREEMENT FOR ADVANCED TRAFFIC MANAGEMENT SYSTEM AND COMMUNICATIONMAINTENANCE AND REPAIR SERVICES."
<br />CROSSTOWN JOB #2413. ---- — — M _ ..
<br />REVIEWED BY: EUNICE HEREDIA (PG I OF )
<br />CITY OF SANTA ANA
<br />20 CIVIC CENTER PLAZA M-36
<br />SANTA ANA, CA 92702
<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 19Stl-Z094 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD
<br />
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