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AC RO® CERTIFICATE OF LIABILITY INSURANCE
<br />DATE MMIDD8 fYYYY)
<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
<br />Cavignac & Associates
<br />450 B Street, Suite 1800
<br />San Diego CA 92101
<br />CONTACT
<br />Certificate Department
<br />PHONE FAx
<br />_(A/c. No Ext)• 619-744-0574 IA/c No): 619-234-8601
<br />ADDRESS: certificates@cavignac.com
<br />INSURER(S) AFFORDING COVERAGE
<br />NAIC #
<br />INSURER A: Valley Forge Insurance Company
<br />20508
<br />INSURED NV51NCO-01
<br />CivilSource, Inc.
<br />9890 Irvine Center Drive
<br />INSURER B: Continental CasualtyCo.
<br />20443
<br />INSURERC: Continental Insurance Company
<br />35289
<br />INSURERD: National Fire Ins. Hartford
<br />20478
<br />Irvine, CA 92618
<br />INSURER E : Berkley Insurance Company
<br />j 32603
<br />INSURER F :
<br />COVERAGES CERTIFICATE NUMBER:412150774 REVISION NUMBFR-
<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 />ILTR
<br />TYPE OF INSURANCE
<br />IN Dp
<br />'C
<br />'go POLICY NUMBER MMI DY EFF
<br />POLICYEXP I LIMITS
<br />MM DD
<br />A
<br />X
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE ; OCCUR
<br />Cross Liab/Sevin
<br />Y
<br />Y
<br />6057040530
<br />5/1/2018
<br />5/1/2019
<br />I�,
<br />;EACH OCCURRENCE
<br />DAMAGE TO RENTED
<br />PREMISES Ea occurrence
<br />$ 1,000,000
<br />$ 1,000,000
<br />MED EXP (Any one person)
<br />$ 15,000
<br />P$0
<br />Deductible
<br />PERSONAL & ADV INJURY
<br />$ 1,000,000
<br />'LAGGREGATE LIMIT APPLIES PER:
<br />POLICY X JE' '[E LOC
<br />GENERAL AGGREGATE
<br />$ 2,000,000
<br />PRODUCTS - COMP/OP AGG
<br />$ 2,000,000
<br />Stop Gap Liability
<br />$ 1,000,000
<br />OTHER:
<br />i
<br />B
<br />AUTOMOBILE
<br />LIABILITY
<br />Y'. Y
<br />6057040575
<br />5/1/2018
<br />5/1/2019
<br />COMBINED SINGLE LIMIT
<br />(Ea accident)
<br />$ 1 000 000
<br />- BODILY INJURY (Per person)
<br />$
<br />ANY AUTO
<br />i
<br />ALL OWNED SCHEDULED
<br />AUTOS AUTOS
<br />BODILY INJURY (Per accident)
<br />$
<br />NON -OWNED
<br />HIRED AUTOS AUTOS
<br />PROPERTY DAMAGE
<br />Per accident
<br />$
<br />$
<br />C
<br />X UMBRELLA LIAB X
<br />OCCUR
<br />6057187219 5/1/2018
<br />5/1/2019
<br />EACH OCCURRENCE
<br />I $ 20,000,000
<br />AGGREGATE
<br />$ 20,000,000
<br />EXCESS LIAB �I
<br />CLAIMS-MADE
<br />DED I X RETENTION $()
<br />$
<br />D
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY Y / N
<br />ANY PROPRIETOR/PARTNER/EXECUTIVE
<br />OFFICER/MEMBER EXCLUDED? F
<br />N / A
<br />Y
<br />6057040558
<br />5/1/2018 5/1/2019 X I SPER TATUTE I 1OTRH-
<br />.
<br />E.L. EACH ACCIDENT $ 1,000,000
<br />j
<br />(Mandatory in NH)
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE - EA EMPLOYEE $ 1,000,000
<br />E.L. DISEASE - POLICY LIMIT $ 1.000,000
<br />E Professional Liability
<br />AEC902036802 1/1/2018
<br />5/1/2019 Each Claim $10,000,000
<br />Aggregate $20,000,000
<br />DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
<br />Re: A-2015-163 OnCall & A-2015-237 OnCall, A-2016-283, A-2018-159-05, A-2018-160-04, RFP #17-034 Construction Engineering -Walnut Pump Station
<br />Building upgrade and San Lorenzo Sewage Lift Station. Additional Insured coverage applies to General Liability and Automobile Liability for City of Santa Ana
<br />and their officers, agents and employees per policy form. Waiver of subrogation applies to General Liability, Automobile Liability, and Workers Compensation
<br />per policy form. Professional Liability - Claims made form, defense costs included within limit. Excess/Umbrella policy follows form over underlying policies:
<br />General Liability, Auto Liability & Employers Liability (additional insured and waiver of subrogation apply). Primary coverage applies to General Liability per
<br />policy form. If the insurance company elects to cancel or non -renew coverage for any reason other than nonpayment of premium they will provide 30 days
<br />notice of such cancellation or nonrenewal.
<br />r
<br />CivilSource, Inc. is a named insured on NV5 Global, Inc Master insurance policy coverages. P9_ of
<br />CERTIFICATE HOLDER CANCELLATION REVIEWSBy Margaret Mercer a t1f:05am,Aug08,201s
<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 />20 Civic Center Plaza AUTHORIZED REPRESENTATIVE
<br />Santa Ana CA 92701
<br />© 1988-2014 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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