W.A. RASIC CONSTRUCTION COMPANY, INC. (2)

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ACORa �i CERTIFICATE OF LIABILITY INSURANCE 4/20/2018 ) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE L;OES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsements . PRODUCER CONTACT NAME: PHONEExr, (714)524-4949 FAX (714)524-4940 Commercial Associates Insurance 1594 N. Batavia Street E-MAIL BESS Orange, CA 92867 INSURERS AFFORDING COVERAGE NAICN INSURER A:Travelers Indemnit Co of CT 25682 INSURED INSURER B INSURER C: W.A. Rasic Construction Co., Inc. INSURER D: 4150 Long Beach Blvd. INSURERE: Long Beach, CA 90807 INSURER F : COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADOL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS GENERALLIABILITY EACH OCCURRENCE $ 2, 000, 000 A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR X T22-CO-867OX247-TCT-18 /1/2018 /1/2019 DAMAGE TO RENTED PREMISES Ea occurrence $ 300,000 MED EXP(Any one person) $ 10,000 PERSONAL B ADV INJURY $ 2,000,000 GENERAL AGGREGATE $ 4,000,000 GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGO $ 4,000,000 $ 17 POLICY F7 PRO LOD AUTOMOBILE LIABILITY O (Ea BINEDI SINGLE LIMIT 2,000,000 X BODILY INJURY (Per person) $ A ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS T-810-867OX247-TCT-18 /1/2018 /1/2019 BODILY INJURY (Per accident) $ PROPERTY DAMAGE Peraccidenl $ HIRED AUTOS NON -OWNED AUTOS Uninsured motorist Combined $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED RETENTION$ $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS' LIASILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? NIA E. L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYE $ (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required) Re: Operations usual to the named insured - Master Service Agreement - On -call emergency sewer and water systems repair services contract City of Santa Ana, its officers, employees, agents, volunteers and representatives are added as additional insured including primary wording where required by written contract as respects general liability per attached CGD246 8/05. 30 days notice of cancellation except 10 days for non-payment. CERTIFICATE City of Santa Ana 220 S. Daisy Ave., M-85 P.O. Box 1988 Santa Ana, CA 92703 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Y/ I! V ACORD 25 (2010105) © 198 - 010 ACO CORPORATION. All rights reserved. I NS025(201005).01 The ACORD name and logo are register mar 1 ORD