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TEROBERT-0
<br />KSHIPPEY
<br />"'� CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY)
<br />9/12/2019
<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 pollcy(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 endorsements
<br />PRODUCER License # 0757776
<br />Newport Beach, CA - HUB International Insurance Services Inc.
<br />4695 MacArthur Court, Suite 600
<br />Newport Beach, CA 92660'E
<br />.
<br />CONTACT Kimberly Shippey
<br />PNONE FAX
<br />uC, No, Eel: INC,N.:
<br />. kimberl .ahl ey@hubinternational.com
<br />INSURE S I AFFORDING COVERAGE
<br />NAIC#
<br />INSURED
<br />INSURERA:01d Republic General Insurance Corp.
<br />INSURER B:Travelers Property Casualty Company of America
<br />24139
<br />25674
<br />INSURER C:
<br />T.E. Roberts, Inc.
<br />306 W. Katella Ave Unit B
<br />Orange, CA 92867
<br />INSURER D:
<br />INSURER E:
<br />INSURER F:
<br />REVISION NUMBER: 01
<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 AN CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED SY 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 />TYPE OF INSURANCE
<br />ADDL
<br />SUBS
<br />p
<br />POLICY NUMBERIMMMrdyyy)q
<br />POLICY EFF
<br />911/2019
<br />9/1/2019
<br />9I1I2019
<br />9/1/2019
<br />POUCYEXP
<br />9/1/2020
<br />9/1/2020
<br />9/1/2020
<br />9/1/2020
<br />LIMITS
<br />A
<br />A
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE OCCUR
<br />X
<br />X
<br />N/A
<br />AICGI3971801
<br />ICA13971801
<br />UP-91N03112-19-NF
<br />ICW13971801
<br />EACH OCCURRENCE
<br />1,000,000
<br />DAMAGE TO REMEDPREMISES ME �ej
<br />E 100r000
<br />6,000
<br />MED EXP An onePerson)
<br />PERSONAL B ADV INJURY
<br />1,000,000
<br />GENL
<br />AGGREGATE LIMIT APPLIES PER:
<br />POLICY ❑X JELT LOC
<br />OTHER:
<br />"AUTOMOBILE LIABILITY
<br />OPEDONLYAUTOS
<br />SCHEDULEDY AUTNNOS��AA..NNEEDpBOOpDILY
<br />Y X AUT0ONLV
<br />LIAB X OCCUR
<br />e CUIMS-MADE
<br />GENERAL AGGREGATEE
<br />2,000,000
<br />PRODUCTS-COMP/OPAGG
<br />$ 2,000,000
<br />(COMBINED Eaawo.rt) LE LIMIT
<br />BODILY I JURY Per emon
<br />$
<br />S 11000,000
<br />$
<br />INJURY Per ectldard
<br />$
<br />PPerVMMY �) `E
<br />$
<br />EACH OCCURRENCE
<br />$ 10,000,000
<br />AGGREGATERETENTIONS
<br />10,000
<br />AND EMPS YERS' ABIUT
<br />ANDEMPLOYERS' DABILPY
<br />ANY pPpROPMUORIPARTNERIEXECUTIVE YIN
<br />(Mentlatory In NHJ EXCLUDED'
<br />if
<br />Dyes, des'ON ender
<br />DESCRIPTION OF OPERATIONS Ielow
<br />X PERTATUIE OTH-
<br />$ 10,000,000
<br />E.L EACH ACCIDENT
<br />$ 1,000,000
<br />E.L DISEASE - EA EMPLOYE
<br />$ 1,000,000
<br />E.L. DISEASE - POLICY UMIT
<br />1,000,000
<br />DESCRIPTION OFOPERATIONS/LOCATIONS /VEHICLEStACORD101,Addldomi Remarks Schedule, ma be attached ifmorespaeela required)
<br />Re: Agreement for #8208- On Call Sewer and Water System Repair Services; A-201v9-0142-03,A-2014-230-01, IFB 16.104 Water Meter Vault Replacement
<br />City of Santa Ana, its officers, employees, agents, volunteers and representatives are included as additional insureds, as respects general liability and auto
<br />liability, which is primary and non-contributory, subject to the terms and conditions of the policy, and attached forms. Separation of Insureds applies. 30
<br />days notice of cancellation, 10 days for non-payment of premium.
<br />REVIEWED & APPROVED
<br />By RI MANAGEMENT DIVISION
<br />rPPTTclrerc Unr nco 11 1 Air-M
<br />City of Santa Ana SAN
<br />Risk Management Division, 4th Floor
<br />20 Civic Center Plaza
<br />Santa Ana, CA 92702
<br />e Cnon oe ronnem-a.
<br />ULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />M. LAMB RrE EDANCXPIRATION WITH THE POT EREOF,PROVIONS.NOTICE WILL BE DELIVERED IN
<br />AUTHORIZEE�D/, �RR�EEP�PP/RESENTATIVE
<br />��
<br />IBDe-ZUTDACUKU CORPORATION. All rights reserved.
<br />The ACORD name and logo are registered marks of ACORD
<br />
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