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.4� „/2'O® CERTIFICATE OF LIABILITY INSURANCE
<br />DATE(10 /2016'YY)
<br />09/02/2018
<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 have ADDITIONAL INSURED provisions or be endorsed.
<br />If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on
<br />this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
<br />PRODUCER
<br />ADO Risk Services Central, Inc.
<br />Pittsburgh PA Office
<br />CONTACT
<br />NAME:
<br />_ _
<br />loo �No, Ext): (866) 283 -7122 (We No): (800) 363 -0105
<br />Dominion Tower, 10th Floor
<br />625 Liberty Avenue
<br />EMAIL
<br />ADDRESS:
<br />INSURERS) AFFORDING COVERAGE
<br />NAIC#
<br />Pittsburgh PA 15222 -3110 USA
<br />INSURED
<br />INSURER A: Liberty Mutual Fire Ins CO
<br />23035
<br />Michael Baker International. Inc.
<br />PO Box 57057
<br />Irvine CA 92619 -7057 USA
<br />INSURER e: Liberty Insurance Corporation
<br />42404
<br />INSURER C: National Union Fire Ins Co of Pittsburgh
<br />19445
<br />INSURER D: Lloyd's syndicate No. 2623
<br />AA1128623
<br />NSURER E:
<br />DAMAGE TO RENTED
<br />PREMISES Ea occurrence
<br />INSURER F.
<br />X
<br />MED EXP(Any one person)
<br />COVERAGES CERTIFICATE NUMBER: 570063542391 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 />INSR
<br />LTR
<br />TYPE OF INSURANCE
<br />AD
<br />MSD
<br />SUER
<br />WVD
<br />POLICY NUMBER
<br />MM/OD
<br />POLICYYYY
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />TB 2681004145IIH
<br />05/30/2016
<br />06/30/2017
<br />EACH OCCURRENCE
<br />$2,000,000
<br />CLAIMS -MADE X❑ OCCUR
<br />DAMAGE TO RENTED
<br />PREMISES Ea occurrence
<br />$100,000
<br />X
<br />MED EXP(Any one person)
<br />$5,000
<br />Contractual Liability
<br />PERSONAL B ADV INJURY
<br />$2,000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER
<br />GENERALAGGREGATE
<br />$4,000,000
<br />POLICY PRO ECT ❑X LOC
<br />PRODUCTS - COMP /OP AGG
<br />$4,000,000
<br />OTHER:
<br />A
<br />AUTOMOBILE LIABILITY
<br />A52 -681- 004145 -726
<br />08/30/201608/30
<br />/2017
<br />COMBINED SINGLE LIMIT
<br />Ea accident
<br />$2,000,000
<br />BODILY INJURY (Par person)
<br />X ANYAUTO
<br />BODILY INJURY (Par accident)
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />HIREDAUTOS NON -OWNED
<br />ONLY AUTOS ONLY
<br />PROPERTY DAMAGE
<br />Peraccident
<br />C
<br />X
<br />UMBRELLA LIAR
<br />X
<br />OCCUR
<br />BL060476715
<br />08/30/2016
<br />08/30/2017
<br />EACH OCCURRENCE
<br />$10,000,000
<br />EXCESS JAG
<br />CLAIMS -MADE
<br />AGGREGATE
<br />$10,000,000
<br />DED I X
<br />RETENTION $10, 000
<br />B
<br />B
<br />WORKERS COMPENSATION AND
<br />EMPLOYERS'LIABILITY YIN
<br />ANY PROPRIETOR I PARTNER I EXECUTIVE
<br />OFFICER /MEMBER EXCLUDED?
<br />(Mandatory In NH)
<br />N/A
<br />WA768DO04145776
<br />ADS
<br />wC7681004145786
<br />WE
<br />08/30/2016
<br />08/30/2016
<br />08/30/2017
<br />08/30/2017
<br />10 X PER TH-
<br />STATUTE ER
<br />EL EACH ACCIDENT
<br />$1,000,000
<br />F ., DISEASE -EA EMPLOYEE
<br />$1,000,000
<br />Eyes, describe untler
<br />DESCRIPTION OF OPERATIONS below
<br />E. L. DISEASE - POLICY LIMIT
<br />$1,000,000
<br />D
<br />E &O -PL- Primary
<br />QC1602675
<br />08/31/2016
<br />08/31/2017
<br />Per claim
<br />$5,000,000
<br />Professional & Pollution
<br />Aggregate
<br />$5,000,000
<br />SIR applies per policy terns
<br />& condi
<br />ions
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required)
<br />RE: Environmental services and Technical studies. City of Santa Ana, its officers, agents, volunteers, employees and
<br />representatives are Additional Insured as respects to General Liability as required by written contract.
<br />CERTIFICATE HOLDER
<br />CANCELLATION
<br />©1988 -2015 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
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<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 />AUTHORIZED REPRESENTATIVE
<br />Attn: Tonia Zerba
<br />20 civic Center Plaza
<br />PO BOX 1988
<br />US
<br />Santa Ana CA 92702 USA
<br />/nLpuYeOeSJ�
<br />ll.GYLL^d
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<br />©1988 -2015 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
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