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ACORO0
<br />AC� CERTIFICATE OF LIABILITY INSURANCE
<br />DATE (MM/DD/YYYY)
<br />1/15/2018
<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(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 does not confer rights to the
<br />certificate holder in lieu of such endorsement(s).
<br />PRODUCER
<br />CONTACT Erica Hornaday
<br />The Empire Company
<br />PHONE FAX
<br />-(A/C No Ext): (AIC, Not:
<br />E-MAIL
<br />ADDRESS: ehornaday @empire-co.com
<br />550 North Park Center Drive
<br />INSURER(S) AFFORDING COVERAGE NAIC #
<br />Suite 205
<br />INSURERA:Citizens Insurance Company of
<br />Santa Ana CA 92705
<br />INSURED
<br />INSURERB:Allmerica Financial Benefit
<br />Transportation Studies, Inc.
<br />INSURER C:Massachusetts Bay Com y
<br />2640 Walnut Avenue
<br />.Insurance -an
<br />.......... ......------�
<br />INSURERD:United States Liability_ Insurance ;25895
<br />Unit L
<br />INSURER E:
<br />Tustin CA 92780
<br />INSURER F.
<br />COVERAGES CERTIFICATE NUMBER: 2017/2018 Master REVISION NUMBER:
<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!ADDL
<br />SUBR, POLICY EFF
<br />POLICY EXP -
<br />LTR
<br />TYPE OF INSURANCE
<br />POLICY NUMBER IMM,,,YY
<br />MM DD/YYYY LIMITS
<br />X COMMERCIAL GENERAL LIABILITY
<br />EACH OCCURRENCE $ 1,000,000
<br />A
<br />CLAIMS -MADE . X OCCUR300,000
<br />DAMAGE TO RENTED
<br />PREMISES (Ea occurrence) _ $
<br />OB3A11724804 10/1/2017
<br />10/1/2018 MED EXP (Any one person) $ 5,000
<br />PERSONAL & ADV INJURY $ 1,000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />GENERAL AGGREGATE ! $ 2,000,000
<br />POLICY PRO
<br />X LOC
<br />JECT
<br />PRODUCTS COMP/OP AGG $ 2,000,000
<br />,
<br />OTHER:
<br />$
<br />AUTOMOBILE LIABILITY
<br />j
<br />COMBINED SINGLE LIMIT
<br />�. (Ea accident).. _ $ 1,000,000
<br />X ANY AUTO
<br />I
<br />I BODILY INJURY (Per person) $
<br />B
<br />ALL OWNED SCHEDULED
<br />AUTOS AUTOS
<br />AW3A11710504 10/1/2017
<br />10/1/2018 BODILY INJURY (Per accident) $
<br />NON -OWNED
<br />HIRED AUTOS AUTOS
<br />PROPERTY DAMAGE $ -- --
<br />mer acadentj -----
<br />$
<br />X
<br />UMBRELLA LIAB OCCUR
<br />EACH OCCURRENCE $ 1,000,000
<br />A
<br />EXCESS LIAB CLAIMS -MADE
<br />I
<br />AGGREGATE $ 1,000,000
<br />DED RETENTION$
<br />i
<br />IOB3A11724804
<br />10/1/2017
<br />10/1/2018 '.$
<br />WORKERS COMPENSATION i,
<br />PER OTH-
<br />AND EMPLOYERS' LIABILITY Y / N
<br />}S:_.':- STATUTE. _',_ ER___
<br />ANYPROPRIETORIPARTNER/EXECUTIVE
<br />- E.L.EACHACCIDENT $ 1,000,000__
<br />OFFICER/MEMBER EXCLUDED? , NIA
<br />(Mandatory in NH)
<br />WH3A11729404 10/1/2017
<br />- - - — -- - ---
<br />10/1/2018: E.L. DISEASE - EA EMPLOYEE $ 1 000 000
<br />-- �f
<br />If yes, describe under
<br />_-- --
<br />DESCRIPTION OF OPERATIONS below
<br />- E.L. DISEASE - POLICY LIMIT $ 1,000,000
<br />D ERRORS & OMISSIONS
<br />SP1022743F 10/1/2017
<br />10/1/2018 ',LIMIT 1,000,000
<br />i
<br />DEDUCTIBLE 1,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
<br />Re: Agreement to Provide Traffic Counting Services on an On -Call Basis
<br />The City of Santa Ana, its officers, employees, agents, volunteers and representatives are named as
<br />additional insureds with primary/non-contributory wording in respect to the general liabilty coverage per
<br />forms 391-1006 08 16 & 391-1003 08 16 attached as required by written contr
<br />REVIEWED BY: EUNICE HEREDIA (PG I OF )
<br />11 r_
<br />ZKekula@santa-ana.org
<br />City of Santa Ana
<br />20 Civic Center Plaza, M-43
<br />Santa Ana, CA 92702
<br />ACORD 25 (2014/01)
<br />INS025 (201401)
<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 />Erica Hornaday/ERICA
<br />©1988-2014 ACORD CORPORATION. All rights reserved.
<br />The ACORD name and logo are registered marks of ACORD
<br />
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