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ACORbr, CERTIFICATE OF LIABILITY INSURANCE
<br />'
<br />DATE(MMIDDNYYY)
<br />05/26/2017
<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($), AUTHORIZED
<br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
<br />IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the policy(les) 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 dons not confer rights to the
<br />certificate holder in lieu of such andorsoment s).
<br />PRonucER LICENSE N0, 0637$31
<br />PATRICK MCRAE INSURANCE SERVICES
<br />1265 N. MANASSERO ST. SUITE 303
<br />ANAHEIM HILLS, CA 92807
<br />NAME: PATRICK MCRAE
<br />PHOONNEgy�sfl. (714 779.6999 _ FAX
<br />1. (714) 779-6903
<br />EMaa ADDRESS: moraeCa7sbcglobal.net __
<br />—�..—_—
<br />INSURCR(&) APPORpIN6 COVERAGE
<br />NAIL i
<br />IN8URERAI COLONY INSURANCE COMPANY
<br />39993
<br />—__...—..____..._..
<br />INSURED
<br />_ _
<br />INSURER D; INSURANCE COMPANY OF THE WEST
<br />---------
<br />._.._
<br />27847
<br />----
<br />INSURER C :. CENTURY -NATIONAL INSURANCE CO.
<br />-
<br />26905
<br />CROSSTOWN ELECTRICAL & DATA, INC.
<br />5464 DIAZ STREET
<br />IRWINDALE CA 91706
<br />—"AN ------ ---
<br />..LNsuaER D; TOPA INSURANCE COMPANY
<br />'180--
<br />34
<br />3$
<br />_ _
<br />INCUBUS E; TOKIO MARINE SPECIALTY INSURANCE CO
<br />_
<br />23850
<br />--
<br />INSURERF:
<br />--
<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 -.
<br />PO1I,,C EFP POLICY EXP--_....._�...--._.—.__.._._
<br />L TYPE QF INSURANCB POLICY NUMBER ! D V Y MMIUO YYY LIMITS
<br />RfL
<br />A
<br />X
<br />_
<br />X
<br />GOMMERCIALGENERALLIABILITY
<br />CLAIMS•MADE LK OCCUR
<br />XCU
<br />X
<br />X
<br />103GL0014267.01
<br />DEDUCTIBLE $5,000 PER
<br />OCCURENCE
<br />06/03/201706/0
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />BAMA(�I�O FiI: lED
<br />PREF$.Eaoccurrencej_-,
<br />S _ 100,000
<br />MEOEXP(Anyme arson)
<br />$ 5,000
<br />PERSONAL &ADV INJURY
<br />$ 1,0_00,000
<br />AGGREGATE LIMIT APPLIES PER:
<br />POLICY D jegOT E] LOS
<br />_
<br />GENERAL AGGREGATE_
<br />GEN'L
<br />_
<br />PRODUCTS-COMPIOPAGG
<br />$ 2,000,000
<br />$
<br />OTHER:
<br />C
<br />AUTOMOBILE
<br />X
<br />LIABILITY
<br />ANY AUTO
<br />X
<br />X
<br />BAP0171987
<br />11/05/201611/05/2017
<br />coMeINEOPI G ELI IT
<br />1000 ,,000
<br />—_$
<br />BODILY INJURY (For person)
<br />""'-"'
<br />$
<br />_
<br />X
<br />ALL OWNED SCHEDULED
<br />AUTOS X AD
<br />NON -OWNED
<br />HIRED AUTOS X AUTOS-
<br />"-----"--'
<br />$ODILY INJURY (Per aocldent)
<br />$ -
<br />Pii PERTV AMAOE
<br />-
<br />$
<br />_
<br />E
<br />X
<br />UMBRELLALIAB
<br />EXCESSLIAB
<br />X
<br />OCCUR
<br />CLAIMS -MADE
<br />PU6535602
<br />UNDERLYING LIMITS:
<br />GLi AL; EL POLICIES
<br />D6/03/201706/03/2018
<br />_
<br />EACH OCCURRENCE
<br />AGOREGA'rE
<br />_$___10,000,009
<br />$ 10,000,000
<br />X
<br />OF.O
<br />RETENTION$ 0
<br />-----..__...—_--
<br />g
<br />wORrcERscaMPENSATION
<br />AND EMPLOYERS'LIABILIT' YIN
<br />ANYPROPRICTORIPARTNERIEXECUTIVE
<br />OFFICERIMEMBER EXCLUDED?
<br />(MandatmyinNH)
<br />IFyes, se be under
<br />DESCRIPTION OF OPERATIONS helm REVI-WED
<br />NIA
<br />x WVE5030354-02
<br />BY CUNICEHEREDIA(PG_
<br />C 66 5I79
<br />$1,000 DEDUCTIBLE
<br />GOV. INCL. THEFT
<br />06/03{201706/03/2018
<br />0$/10/20170$!10/2018
<br />OF _.
<br />X sER ...7�__��_
<br />RL.EACHACCIDENT
<br />,—
<br />$ 1 000,000
<br />GL.DISEASE•EAEMPLOYEE-
<br />-
<br />S 1 QOQ.,000
<br />C.L. DISEASE LIMIT
<br />e 1,OQD,D66
<br />D
<br />PROPER
<br />CONTRACTORS
<br />EOUIPMENT
<br />13&19 ednpe
<br />$ BS, /6S BPP
<br />$300ee Lemenyml Premlees
<br />$300,0o 0BVEEO aPP
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Romarka Sohedule, ma be affached If mere s noa Is roryuirod
<br />CITY OF SANTA ANA, MICHAEL BAKER, INTERNATIONAL, OCTA, CITY OF BREA, CITY 0 ANAHEIM, CITY OF ORANGE, �ALTRANS, CITY OF PLACETIA, ALONG WITH
<br />T14EIR OFFICERS, OFFICIALS, AGENTS, EMPLOYEES AND VOLUNTEERS ARE NAMED AS ADDITIONAL INSURED WITH RESPECTS TO THE ABOVE MENTIONED
<br />POLICIES PER ATTACHED ENDORSEMENT(S). COVERAGE IS PRIMARY & NON-CONTRIBUTORY AS REQUIRED BY WRITTEN CONTRACT, PER ATTACHE[)
<br />ENDORSEMENT FORMS, WAIVER OF SUBROGATION APPLIES, IF REQUIRED BY WRITTEN CONTRACT.
<br />"SSHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, A 30 DAY WRITTEN NOTICE WILL BE ISSUED,
<br />RE: PROJECT NAME: GRAND AVE RTSSP PROJECT NO.: 14-6817 CROSSTOWN R 3435 PROJECT LOCATION: GRAND AVE
<br />CITY OF SANTA ANA
<br />20 CIVIC CENTER PLAZA
<br />SANTA ANA CA 92701
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH T14E POLICY PROVISIONS,
<br />AUTHORIZED REPRESENTATIVE
<br />@)1988.2014
<br />IIY67i•�e\R7fY1:SC
<br />ACORD 25 (2014101)
<br />The ACORD name and logo are registered marks of ACORD
<br />
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