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Client#: 25181 PSOMAS <br />ACORD,,, CERTIFICATE OF LIABILITY INSURANCE DATE(MMnar9yf1n•1 I <br />ninY11 a <br />THIS CERTIFICATE IS ISSUED ASA 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(les) must have ADDITIONAL INSURED provlslons 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 any rights to the certificate holder in lieu of such endorsement(s). <br />PRODUCER <br />CCT <br />N Katie Krasner <br />Greyling Ins. Brokerage/EPIC <br />Exl 770,552.4225 A/c No; 866.550.4082 <br />3780 Mansell Road, Suite 370 <br />MAL <br />ADDRESS: Katle.Kresner@grsyling.com <br />Alpharetta, GA 30022 <br />INSURERS AFFORDING COVERAGE NAIC # <br />04101/201 <br />INSURER A: Nn11onN Unlon Fire Ins. co. 19445 <br />PREMISEES ELATE De . $500,000 500 000 <br />INSURED <br />Psomas <br />INSURER e <br />INSURER C.. <br />555 South Flower Street; Suite 4300 <br />INSURERD: <br />Los Angeles, CA 90071 <br />INSURER E: <br />A <br />INSURER F: <br />LIABILITY <br />ANY AUTO <br />AUTO& ONLY X AUT09U�D <br />HIRED NON -OWNED <br />AUTOS ONLY AUTOS ONLY <br />COVERAGES CERTIFICATE NUMBER: 18-19 REVISION NUMBER: <br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVEBEENISSUED TOTHE INSURED NAMEDABOVE FORTHE POLICYPERIOD <br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR 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 />L'IR <br />TYPE OF INSURANCE <br />INSR <br />y VD <br />POLICY NUMBER <br />PMILKS <br />(0 0% <br />LIMITS <br />A <br />X COMMERCIAL GENERAL LIABILITY <br />CLAIMS -MADE 7 OCCUR <br />GL5268212 <br />0410112018 <br />04101/201 <br />EACH $1000000 <br />PREMISEES ELATE De . $500,000 500 000 <br />MED EXP (Anyone person) $25 OOO <br />PERSONAL &ADV INJURY $1,000,000 <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />POLICY � JPEC O LOC <br />OTHER: <br />GENERAL AGGREGATE s2,000,000 <br />PRODUCTS -COMP/OP AGO $2,000,000 <br />$ <br />A <br />AUTOMOBILE <br />X <br />X <br />LIABILITY <br />ANY AUTO <br />AUTO& ONLY X AUT09U�D <br />HIRED NON -OWNED <br />AUTOS ONLY AUTOS ONLY <br />CA4489706 <br />4/01/2018 <br />04/01/2019CO <br />eccldeDlS N LE L M T $1,06,000 <br />BODILY INJURY (Per person) $ <br />BODILY INJURY (Per accldenl) $ <br />PROPERTYDAMAGE $ <br />Per accident <br />S <br />UMBRELLA LIAROCCUR <br />EXCESS LIAR <br />CLAIMS -MADE <br />EACH OCCURRENCE $ <br />AGGREGATE $ <br />DED I I RETENTION$ <br />$ <br />A <br />A <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY <br />ANY PROpRR ETOoRlPAR7NERlEXECUTIVE Y IN <br />OFFICE RPNI�MBEREXCLUDED? ON <br />(Mandatory In NH) <br />Il yyes describe under <br />DESGLRIPTION OF OPERATIONS below <br />NIA <br />WC015893765 (CA) <br />WC015893764 AOS <br />(AOS) <br />4/01/2018 <br />4!0112018 <br />0410112019_X_jjLUM <br />041011201 <br />I <br />ER OTH- <br />E.L. EACH ACCIDENT $1,000,000 <br />E.L. DISEASE • EA EMPLOYEE $1,000.000 <br />E.L. DISEASE -POLICY LIMIT 1$1,000,000 <br />REVIEWED BY: EUNICE HEREDIA (PG F <br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be alteched If more apses Is required) <br />4SAN020200; GIS Needs Assessment & Implementation Plan & Enterprise Asset Needs Assessment & Implementation <br />Plan. The City of Santa Ana, Its officers, employees, agents, volunteers & representatives are named as <br />Additional Insureds with respects to General Liability where required by written contract. The above <br />referenced liability policies are primary & non-contributory where required by written contract, Waiver of <br />Subrogation is applicable where required by written contract & allowed by law. Should any of the above <br />(See Attached Descriptions) <br />City of Santa Ana <br />Public Works Department <br />Trevor Burgan <br />20 Civic Center Plaza <br />Santa Ana, CA 92702.0000 <br />ACORD 25 (2016103) 1 of 2 <br />#S1033021/M1032607 <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 />A54W. <br />©1988.2015 ACORD CORPORATION. All rights reserved. <br />The ACORD name and logo are registered marks of ACORD <br />KKRE1 <br />