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NICHCON-02 MCGRAWM
<br />CERTIFICATE OF LIABILITY INSURANCE DATD/YYYY)
<br />9//28/228/2017
<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(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.
<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 rights to the certificate holder in lieu of such endorsement(s).
<br />PRODUCER License # OE67768 CONTACT Erica Wilson
<br />NAME:
<br />IDA Insurance Services PHONE
<br />4370 La Jolla Village Drive (A/C, No, Ext): (858) 754-0063 50233 FAX No):(619) 574-6288
<br />Suite 600 AD RIESS: Er
<br />ica.Wilson@ioausa.com
<br />San Diego, CA 92122
<br />INSURER(S) AFFORDING COVERAGE NAIC #
<br />INSURER A: RLI Insurance Company 13056
<br />INSURED INSURER B: Crum & Forster Specialty Insurance Company 44520
<br />Nichols Consulting Engineers, CHTD INSURER C:-
<br />1885 S. Arlington Ave., #111 INSURER D:
<br />Reno, NV 89509
<br />INSURER E:
<br />INSURER F;
<br />CnVFRAr,FR CFRTIFICATF NIIMRFR- RFVIRIr1N NIIMRFR-
<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
<br />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 TYPE OF INSURANCE ADDL SUBR. POLICY NUMBER
<br />LTR SD
<br />POLICY EFF POLICY EXP LIMITS
<br />MMIDD YY IDD Y
<br />A XI, COMMERCIAL GENERAL LIABILITY ''.
<br />: EACH OCCURRENCE '', $ 1,000,000
<br />CLAIMS MADE X OCCUR PPSB0003222
<br />X
<br />05/17/2017 05/17/2018 DAMAGE TO RENTED 1,000,000
<br />PREMISES (Ea occurrence) $
<br />X Cont LiablSev of IntMED
<br />10,000
<br />EXP (Any one person) $
<br />1,000,000
<br />PERSONAL & ADV INJURY $
<br />_ AGGREGATE LIMIT APPLIES PER:
<br />GENERAL AGGREGATE _ $ 2,000,000
<br />POLICY ( XPE o LOC
<br />;PRODUCTS -COMP/OP AGG $ 2,000,000
<br />--_ 0
<br />':Deductible
<br />OTHER:
<br />$
<br />A AUTOMOBILE LIABILITY-
<br />__-_
<br />COMBINED SINGLE LIMIT 1,000,000
<br />_.(Eaaccident)-. ' $ 1, _.
<br />X II ANY AUTO X PSA0001184
<br />05/17/2017 05/17/2018 BODILY INJURY (Per person) $
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />BODILY INJURY (Per accident) $
<br />HIRED NON -OWNED
<br />AUTOS ONLY ALTOSS ONLY
<br />PROPERTY DAMAGE
<br />(Per accident)
<br />X I Comp.: $ 500 X Coll.: $ 500
<br />$
<br />A UMBRELLA LIAB X OCCUR
<br />! EACH OCCURRENCE $ 5,000,000
<br />X EXCESS LIAB CLAIMS -MADE PSE0003030
<br />05/17/2017 05/17/2018AGGREGATE $ 5,000,000
<br />_-..
<br />DED RETENTION $
<br />$
<br />A WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY
<br />X PER 1 OTH-
<br />.-STATUTE.,.-: 1 ER,,,_ ----
<br />YIN X ',PSW0001955
<br />05/17/2017 05117/2018 1,000,000
<br />ANY PROPRIETOR/PARTNER/EXECUTIVE
<br />OFFICER/MEMBER EXCLUDED? N N I A
<br />E.L.EACH ACCIDENT $
<br />(Mandatory in NH)
<br />: E.L. DISEASE - EA EMPLOYEE'. $ 1,000,000
<br />yes, describe under
<br />1,000,000
<br />DESCRIPTION OF OPERATIONS below
<br />D
<br />E.L. DISEASE- POLICY LIMIT $
<br />B 'Prof Liab/Clms Made PKC105019
<br />05/17/2017 05/17/2018 :Per Claim 2,000,000
<br />B 'IDed.: $1Ok Per Claim PKC105019
<br />05/17/2017 05/17/2018 '',Aggregate 2,000,000
<br />DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule,
<br />may be attached if more space is required)
<br />Re: PAVER to StreetSaver Conversion
<br />City of Santa Ana, its officers, employees, agents and representatives are Additional Insured with respect to General and Auto Liability per the attached
<br />endorsements as required by written contract. Insurance is Primary and Non -Contributory. Waiver of Subrogation applies to Workers' Compensation.
<br />30 Days Notice of Cancellation with 10 Days Notice for Non -Payment of Premium
<br />in accordance with the policy provisio s.
<br />�REVIEWED EIJN)CE FdERFDIA (PG ( OF !` )
<br />City of Santa Ana
<br />20 Civic Center Plaza, M-36
<br />M-36 PO Box 1988
<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 />AUTHORIZED REPRESENTATIVE
<br />ACORD 25 (2016/03) @ 1988-2015 ACORD CORPORATION. All rights reserved.
<br />The ACORD name and logo are registered marks of ACORD
<br />
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