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A RO CERTIFICATE OF LIABILITY INSURANCE
<br />DATE(MM/09/05/22017017 )
<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. If
<br />SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this
<br />certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
<br />PRODUCER
<br />Aon Risk Services Central, Inc.
<br />Pittsburgh PA office
<br />CONTACT
<br />NAME:
<br />PHONE (866) 283-7122 FAX (800) 363-0105
<br />(A/C No. Ext): (ac. No.):
<br />Dominion Tower, 10th Floor
<br />625 Liberty Avenue
<br />E-MAIL
<br />ADDRESS:
<br />INSURER(S) AFFORDING COVERAGE NAIC #
<br />Pittsburgh PA 15222-3110 USA
<br />INSURED
<br />INSURERA: XL insurance America Inc 24554
<br />Michael Baker International, Inc
<br />5 Hutton centre Drive
<br />Suite 500
<br />INSURER B: Liberty Mutual Fire Ins CO 23035
<br />INSURER C: Liberty Insurance Corporation 42404
<br />Santa Ana CA 92707 USA
<br />INSURER D: Lloyd's Syndicate No. 2623 AA1128623
<br />INSURER E:
<br />INSURER F:
<br />COVERAGES CERTIFICATE NUMBER: 570068250186 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 />INSD
<br />WVD
<br />POLICY NUMBER
<br />MMIDDIYYYY
<br />MM/DDIYYYY
<br />LIMITS
<br />B
<br />X COMMERCIAL GENERAL LIABILITY
<br />TB
<br />EACH OCCURRENCE $2,000,000'
<br />General Liability
<br />A. N $300,000
<br />PREMISES Ea occurrence
<br />CLAIMS -MADE X❑ OCCUR
<br />MED EXP (Any one person) $10,000
<br />PERSONAL &ADV INJURY $2,000,000
<br />GEML AGGREGATE LIMITAPPLIES PER:
<br />GENERAL AGGREGATE $4,000,000
<br />POLICYPRO LOC
<br />EJECT
<br />PRODUCTS - COMP/OPAGG $4,000,000
<br />OTHER:
<br />B
<br />AUTOMOBILE LIABILITY
<br />AS2-681-004145-727
<br />08/30/201708/30/2018
<br />COMBINED SINGLE LIMIT $2,000,000
<br />Ea accident
<br />Commercial Auto - ADS
<br />BODILY INJURY ( Per person)
<br />X ANYAUTO
<br />OWNED SCHEDULED
<br />BODILY INJURY (Per accident)
<br />AUTOS ONLY AUTOS
<br />PROPERTY DAMAGE
<br />HIREDAUTOS NON -OWNED
<br />ONLY AUTOS ONLY
<br />Per accident
<br />A
<br />X
<br />UMBRELLALIAB
<br />X
<br />OCCUR
<br />US00079952LI17A
<br />08/30/2017
<br />08/30/2018
<br />EACH OCCURRENCE $10,000,000
<br />umbrella
<br />AGGREGATE $ZO, OOO,000
<br />EXCESS LIAR
<br />CLAIMS -MADE
<br />DED X RETENTION SID, 000
<br />C
<br />ORKS SCOM�PBENSATIONAND
<br />WORKERS
<br />wA768DO04145777
<br />08/30/2017
<br />08/30/2018
<br />X STATUTE OTH-
<br />ER
<br />v/N
<br />workers Comp - ADS
<br />E.L. EACH ACCIDENT $1,000,000
<br />ANY PROPRIETOR/PARTNER/EXECUTIVE
<br />N
<br />OFFICER/MEMBER EXCLUDED?
<br />N / A
<br />E.L. DISEASE -EA EMPLOYEE $1,000,000
<br />(Mandatory in NHi
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE -POLICY LIMIT $1,000,000
<br />D
<br />E&O-PL-Primary
<br />PSDEF170046008/31/2017
<br />08/31/2018
<br />Per Claim $5,000,000
<br />Professional Liab. and CP
<br />Aggregate $5,000,000
<br />SIR applies per policy ter
<br />s & condi
<br />ions
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
<br />For Named Insured Only: Kim Hartsfield. RE: Project Name: Agreement Numbers A-2016-093 & A-2015-170. City of Santa Ana,
<br />its officers, employees, agents and representatives are included as Additional Insured in accordance with the policy provisions
<br />cf thz Gene; i^bil ity ^1 icy. General Liability --i-ed is Primary and Non -Contributory to Dther ilisUi'diiCe
<br />available to an�AdditionalIVlnsured'but only in accordance with the policy's provisions. Should General Liability, Automobile
<br />Liability and Workers' Compensation policies be cancelled before the expiration date there f, the policy provisions will govern
<br />how notice of cancellation may be delivered to certificate Holders in accordance with t olicy provisions of each policy,
<br />REVIEWED BY: EUNICE HEREDIA (PGJ OF )
<br />CERTIFICATE HOLDER CANCELLATION
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
<br />EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE
<br />POLICY PROVISIONS.
<br />City of Santa Ana AUTHORIZED REPRESENTATIVE
<br />Attn: Ross Annex '..
<br />20 Civic Center Plaza, Po Box 1988
<br />Santa Ana CA 92702-1988 USA
<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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