Laserfiche WebLink
Client#: 25181 PSOMAS <br />ACORD.CERTIFICATE OF LIABILITY INSURANCE D Q:3127IDDIYYYY) <br />3127f201 R <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 any rights to the certificate holder in lieu of such endorsement(s). <br />PRODUCER <br />Grayling Ins. BrokeragelEPIC <br />3780 Mansell Road, Suite 370 <br />Alpharetta, GA 30022 <br />W111ACT Katie Kresner <br />NAMEPIF <br />MESE 77Q 552.4225FAX <br />A1c o E>tt; AfC Ne; 866.550.4082 <br />EMAIL.ADDRESS: Katle.Kresner@greyling,com <br />INSURERS) AFFORDING COVERAGE NAIC 0 <br />INSURER A ; National Union Fire Ina, co. 1944.51 <br />X COMMERCIAL GENERAL LIABILITY <br />CLAIMS -MADE O OCCUR <br />INSURED <br />Psomas <br />INSURER B <br />INSURER C; <br />555 South Flower Street; Suite 4300 <br />Los Angeles, CA 90071 <br />INSURER D: <br />INSURER E <br />INSURER F: <br />MED EXP (Any one person) s25,000 <br />COVERAGES CERTIFICATE NUMBER: 18-19 RFVISIArd Nt1MRFR- <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 CONTRACTOR 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 />1 <br />LTR <br />TYPE OF INSURANCE <br />INSR <br />9wVQUBR <br />POLICY NUMBER <br />POLICY <br />YIYEEFF <br />PIMM /YYYY <br />LIMITS <br />A <br />X COMMERCIAL GENERAL LIABILITY <br />CLAIMS -MADE O OCCUR <br />GL5268212 <br />0410112018 <br />04/01/2019 <br />EACHOCCURRENCE $1,000.000 <br />PREMISES Ee o�urrenoe $500,000 500 000 <br />MED EXP (Any one person) s25,000 <br />PERSONAL&ACV INJURY $1,000000 <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />PRO- <br />OLICY � JECT � LDC <br />OTHER: <br />GENERAL AGGREGATE $2,000,000 <br />PRODUCTS-COMP/OP AGG s2,000,000 <br />$ <br />A <br />AUTOMOBILE <br />Ix <br />LIABILITY <br />ANYAEEUTO <br />AUTO60ONLY X SCHEDULEDBODILY <br />I AUTOS <br />AUTOS ONLY AUTOS ONLY <br />CA4489706 <br />0410112018 <br />0410112019 <br />EOMBIN EDtSINGLE LIMIT 1,000,000 <br />BODILY INJURY(Par person) $ <br />INJURY Per accldenl $ <br />( ) <br />PROPERTY DAMAGE $ <br />Per accident <br />UMBRELLA LIAR <br />EXCESS LIAB <br />OCCUR <br />CLAIMS -MADE <br />EACH OCCURRENCE $ <br />AGGREGATE $ <br />DED I I RETENTION <br />$ <br />A <br />A <br />WORKERS COMPENSATION <br />AND EMPLOYERS` LIABILITY <br />ANY PROPRIETOR/PARTNERIEXECUTNY f NE <br />OFFICERIMEMBER EXCLUDED? 7 <br />(Mandatory In NH) <br />If yes, describe under <br />DESCRIPTION OF OPERATIONS below <br />NIA <br />WC01(} 5893765 CA <br />WC015893764 (AOS) <br />410112018 <br />4/0112018 <br />04101!2019 <br />04/01/2019 <br />I <br />PER SIALTUTE OTH- <br />X <br />E.L, EACH ACCIDENT $1,000,000 <br />E.L. DISEASE -EA EMPLOYEE $1,000,000 <br />E.L. DISEASE -POLICY LIMIT $1,000.000 <br />REVIEWED BY: EUNICE HEREDIA (PG 3OF <br />DESCRIPTION OF OPERATIONS/ LOCATIONS I VEHICLES (ACORD 161, Addlllonal Remarks Schedule, maybe attached If more space is required) <br />28AN051100 & 4SAN020200; Agreement Nos. A-2008-219, A-2015-167, A-2017-114 & A-2014-224; City of Santa Ana <br />On -Call Engineering Services 14-037 & GIS Needs Assessment & Implementation Plan & Enterprise Asset Needs <br />Assessment & Implementation Plan. The City of Santa Ana, officers, employees, agents & representatives are <br />named as Additional Insureds with respects to General & Automobile Liability where required by written <br />contract. The above referenced liability policies are primary & non-contributory where required by written <br />(See Attached Descriptions) <br />CERTIFICATE HOLDER rnNI rl I ATInKl <br />City of Santa Ana <br />Public Works Agency <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 />20 Civic Center Plaza, M-21 <br />AUTHORIZEDD REPRESENTATIVE <br />Santa Ana, CA 92702.0000 <br />I 04W. <br />ACORD 25 (2016103) 1 of 2 <br />#S1033020IM1032607 <br />O 1988-2015 ACORD CORPORATION. All rights reserved. <br />The ACORD name and logo are registered marks of ACORD <br />KKRE1 <br />.� <br />ME <br />ac� <br />emr— <br />16�i� <br />