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CERTIFICATE OF LIABILITY INSURANCE
<br />rATE(MMI08/24/20118
<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 />(AIC. No. Ext): (AIC. No.):
<br />EQT Plaza - Suite 2700
<br />625 Liberty Avenue
<br />E-MAIL
<br />ADDRESS:
<br />Pittsburgh PA 15222-3110 USA
<br />INSURER(S) AFFORDING COVERAGE NAIC #
<br />INSURED
<br />INSURERA: Liberty Mutual Fire Ins CO 23035
<br />Michael Baker International, Inc
<br />S Hutton Centre Drive
<br />suite 500
<br />INSURER B: Liberty insurance Corporation 42404
<br />syndicate No. 2623 AA1128623 INSURER C: Lloyd's S
<br />Y Y
<br />Santa Ana CA 92707 USA
<br />INSURER D: XL Insurance America Inc 24554
<br />POLICY ❑X PRO- LOC
<br />JECT
<br />INSURER E:
<br />INSURER F:
<br />\ WV"r%P%WF—Q \ r_rxiiri,-AIC Illuivi CI[: O/UU/L/OOOOI KtVIJIUN NUIVItStK:
<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 />LTPO
<br />R TYPE OF INSURANCE INSD WVD POLICY NUMBER MMIDD/YYYY MMIDDIYYYY LIMITS
<br />A X COMMERCIAL GENERAL LIABILITY TB EACH OCCURRENCE $2 , 000,000
<br />CLAIMS -MADE X❑ OCCUR General Liability A $300,000
<br />PREMISES Ea occurrence)
<br />$10,000
<br />$2,000,000
<br />$4,000,000
<br />$4,000,000
<br />O
<br />0
<br />r`
<br />$2,000,000
<br />0
<br />Z
<br />d
<br />UV
<br />i.
<br />d
<br />10,007000 U
<br />10,000,000
<br />$1,000,000
<br />$1,000,000
<br />$1,000,000 —
<br />$5,000,000 —
<br />$5,000,000
<br />DESCRIPTION OF OPERATIONS (LOCATIONS /VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
<br />RE: Civic Center Stormwater Lift Station Renovation. MB Project No. 167946. Agreement NO. A-2016-093 / A-2015-170 / A-2018-177.
<br />City of Santa Ana, Ross Anex is included as Additional Insured in accordance with the policy provisions of the General
<br />Liability policy.
<br />General Liability evidenced herein is Primary/Non-Contributory to other insurance available to an Additional Insured, but only
<br />in accordance with the policy's Provisions.
<br />Should any of the above described policies be cancelled before the expiration date thereof, the policy provisions will govern
<br />how notice of cancellation may be delivered to certificate holders in accordance with the policy provisions of each policy.
<br />REVIEWED BY. EUNICE HEREDIA (PG P OF F )
<br />CERTIFICATE HOLDER C I ull= Q Ijl v
<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 />MED EXP (Any one person)
<br />City Of Santa Ana, ROSS Anex
<br />20 Civic Center Plaza
<br />PERSONAL& ADV INJURY
<br />P.O. BOX 1988
<br />Santa Ana CA 92702-1988 USA
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<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />GENERAL AGGREGATE
<br />POLICY ❑X PRO- LOC
<br />JECT
<br />PRODUCTS - COMPIOP AGG
<br />OTHER:
<br />A
<br />AUTOMOBILE LIABILITY
<br />AS2-681-004145-728
<br />08/30/2018
<br />08/30/2019
<br />COMBINED SINGLE LIMIT
<br />Commercial Auto - AOS
<br />Ea accident
<br />BODILY INJURY ( Per person)
<br />X ANYAUTO
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />BODILY INJURY (Per accident)
<br />PROPERTY DAMAGE
<br />Per accident
<br />HIREDAUTOS NON -OWNED
<br />ONLY AUTOS ONLY
<br />D
<br />X
<br />UMBRELLA LAB
<br />X
<br />OCCUR
<br />US00079952L118A
<br />08/30/2018
<br />08/30/2019
<br />EACH OCCURRENCE
<br />Umbrella
<br />—
<br />AGGREGATE
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />DED I X RETENTION $10,000
<br />B
<br />WORKERS COMPENSATION AND
<br />EMPLOYERS' LIABILITY YIN
<br />WA768DO04145778
<br />work
<br />workers Comp - AOS
<br />08/30/2018
<br />08730/2019
<br />X PER OTF
<br />STATUTE
<br />E.L. EACH ACCIDENT
<br />ANY PROPRIETOR/ PARTNER/ EXECUTIVE
<br />OFFICER/MEMSER EXCLUDED?
<br />NIA
<br />E.L. DISEASE -EA EMPLOYEE
<br />(Mandatory In NH)
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE -POLICY LIMIT
<br />C
<br />E&O-PL-Primary
<br />PSDEF1800460
<br />08/31/2018
<br />08/30/2019
<br />Per Claim
<br />Professional Liab, and CP I
<br />I
<br />Aggregate
<br />$10,000
<br />$2,000,000
<br />$4,000,000
<br />$4,000,000
<br />O
<br />0
<br />r`
<br />$2,000,000
<br />0
<br />Z
<br />d
<br />UV
<br />i.
<br />d
<br />10,007000 U
<br />10,000,000
<br />$1,000,000
<br />$1,000,000
<br />$1,000,000 —
<br />$5,000,000 —
<br />$5,000,000
<br />DESCRIPTION OF OPERATIONS (LOCATIONS /VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
<br />RE: Civic Center Stormwater Lift Station Renovation. MB Project No. 167946. Agreement NO. A-2016-093 / A-2015-170 / A-2018-177.
<br />City of Santa Ana, Ross Anex is included as Additional Insured in accordance with the policy provisions of the General
<br />Liability policy.
<br />General Liability evidenced herein is Primary/Non-Contributory to other insurance available to an Additional Insured, but only
<br />in accordance with the policy's Provisions.
<br />Should any of the above described policies be cancelled before the expiration date thereof, the policy provisions will govern
<br />how notice of cancellation may be delivered to certificate holders in accordance with the policy provisions of each policy.
<br />REVIEWED BY. EUNICE HEREDIA (PG P OF F )
<br />CERTIFICATE HOLDER C I ull= Q Ijl v
<br />©1988-2015 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
<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, ROSS Anex
<br />20 Civic Center Plaza
<br />AUTHORIZED REPRESENTATIVE
<br />P.O. BOX 1988
<br />Santa Ana CA 92702-1988 USA
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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
<br />
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