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WKEINCO-01 LYN
<br />DATE (MM1DDlYYYY)
<br />CERTIFICATE OF LIABILITY INSURANCE �17/z016
<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 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 License # OE67768 CONTACT Ali Smith
<br />NAME:
<br />IOA Insurance Services PHONE�FAX
<br />4350 La Jolla Village Drive Arc, No, Eaq: 1619} 788-5795 50206 tAA/C, Ne);
<br />Suite 900
<br />ADDRESS: AlLSmith@ioausa.corn -
<br />San Diego, CA 92122 -
<br />INSUREIR(SI AFFORDING COVERAGE _ T,NAIC #
<br />— INSURERA:RLI insurance Com canny 13056 _
<br />INSURED
<br />INSURER B:Atlantic _Specialty Insurance Company _ 127154
<br />WKE,Inc. ,INSURER C: _
<br />400 N. Tustin Ave., #275 I INSURER e: +
<br />Santa Ana, CA 92705
<br />INSURER E:
<br />INSURER F
<br />COVERAGES CFRTIFICOTF hit IPARFR-
<br />--""' RGV10 14 IVlJ1Y101=1C:
<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 ADDL.SUBRJ Y EFF POLICY EXP
<br />-
<br />LTR I TYPE OF INSURANCE SD POLICY POLICY NUMBER FOLIC MIC LIMITS'
<br />A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE _ , $ 2,000,000
<br />CLAIMS -MADE X OCCUR DAMAGE TO RENTED
<br />X X PS80001793 10/11/2016 10!1112017 REMISES Ea occurrence $ 1,000,000
<br />X Cont Liab/Sev of Int
<br />MED EXP (Any ane person) _ IS 10,000
<br />PERSONAL & ADV INJURY $ 2,000,000
<br />GEN`LAGGREGATELIMIT APPLIES PER, i I GENERAL AGGREGATE $ 4,000,000
<br />POLICY X JECT _ I LOC I 4,000,000
<br />OTHER: PRODUCTS - COMP/OPAGG $
<br />Deductible $ 0
<br />A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
<br />$ 2,000,000
<br />_ E eccide�}
<br />ANY AUTO —I PS80001793 10/11/2016 10111/2017 BODILY INJURY {Perperson) is
<br />� OWNED SCHEDULED
<br />I
<br />rAUTOS ONLY AUTOS BODILY INJURY (Per acciden) $
<br />X AUR OS ONLYX AUTOS ON�� PROPERTY DAMAGE
<br />UT !Por accident) $
<br />X Autos ' Owned
<br />$
<br />A X UMBRELLA LIAB 1X OCCUR
<br />I I I EACH OCCURRENCE $ 2,000,000
<br />EXCESS LIAB j CLAIMS-MADEi i PSE0001694 10/1112096110/1112017 AG 2,000000
<br />I AGGREGATE $
<br />DEC) RETENTION $
<br />A ! WORKERS COMPENSATION( X i STATUTE ETH
<br />:AND EMPLOYERS' LIABILITY
<br />ANY PRQPRIETOR/PARTNER/EXECUTIVE YIN X ;PSW0001674 10/11/2016 10111/2017 1,000
<br />O FICERRlMEMBER EXCLUDED? N / A E,L,._EACH ACCIDENT $ ,000
<br />(tandatoryinNH) I El, DISEASE_ - EAEMPLOYEEI$ 1,000,000
<br />Ifyes, describe under
<br />DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,600,000
<br />B Prof LiablClms Made IDPL586016 10/11/2016 10H 1!2017 [Per Claim 21000,000
<br />B Ded.: $25k Clms Made DPL586016 10/11/2016 10/1112017 Aggregate 2,000,000
<br />DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES (ACORD 191, Additional Remarks Schedule, may be attached If more space Is required)
<br />Re: Fairview Ave Bridge at Santa Ana River
<br />City of Santa Ana, its officers, agents, volunteers and employees are Additional Insureds with respect to General Liability per the attached endorsement as
<br />required by written contract. Insurance is Primary and Non -Contributory, Waiver of Subrogation applies to General Liability and Workers' Compensation.
<br />30 Days Notice of Cancellation with 10 Days Notice for Non -Payment of Premium in accordance with the policy pro isions, C
<br />R
<br />REVIEWED (PG
<br />P�. _ J
<br />..___...._. __ .._REVIEWEDD BY: F
<br />:".,"� i.iNl�"Em I-iEi2LI�lA Ct CIF
<br />M'-URLJ La keu-le,vol © 1988-2015 ACORD CORPORATION. All rights reserved.
<br />The ACORD name and logo are registered marks Of ACORD
<br />L..bf11 IL IY
<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 />City of Santa Ana
<br />Attn: Mindy Ly
<br />20 Civic Center Plaza
<br />AUTHORIZED REPRESENTATIVE
<br />Ross Annex (M-36)
<br />Santa An CA 927 1
<br />M'-URLJ La keu-le,vol © 1988-2015 ACORD CORPORATION. All rights reserved.
<br />The ACORD name and logo are registered marks Of ACORD
<br />
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