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A� br CERTIFICATE OF LIABILITY INSURANCE <br />DA9/28/200 8 ) <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 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 Hornada <br />NAME: y <br />PHONE FAX <br />A/C No Ext1: A/C No): <br />The Empire Company <br />550 North Park Center Drive <br />E-MAIL <br />ADDRESS: y p ehornada @em ire-co.com <br />Suite 205 <br />INSURERS AFFORDING COVERAGE NAIL # <br />INSURERA:Ohio Security Insurance Company 24082 <br />Santa Ana CA 92705 <br />INSURED <br />INSURER B: American Fire and Casualty Insurance Cc 24066 <br />INSURERC:United States Liability Insurance Com a 25895 <br />Transportation Studies Inc <br />INSURER D: <br />2640 Walnut Ave Ste L <br />INSURER E: <br />INSURER F: <br />Tustin CA 92780 <br />COVERAGES CERTIFICATE NUMBER: 2018/2019 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 />ILTR <br />TYPE OF INSURANCE <br />ADDL <br />SUER <br />POLICY NUMBER <br />POLICY <br />MM DD/YYYY <br />POLICY EXP <br />MM DDfYYYY <br />LIMITS <br />X COMMERCIALGENERAL LIABILITY <br />EACH OCCURRENCE $ 1,000,000 <br />A <br />CLAIMS -MADE FOOCCUR <br />DAMAGE TO RENTE <br />PREMISES Ea occurrence $ 500,000 <br />MED EXP (Any one person) $ 15,000 <br />BKS59050934 <br />10/1/2018 <br />10/1/2019 <br />PERSONAL & ADV INJURY $ 1,000,000 <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />GENERAL AGGREGATE $ 2,000,000 <br />X POLICY 0 PRO F_� LOCPRODUCTS-COMP/OPAGG <br />JECT <br />$ 2,000,000 <br />$ <br />OTHER: <br />AUTOMOBILE <br />LIABILITY <br />COMBINED SINGLE LIMIT $ 1,000,000 <br />Ea accident <br />BODILY INJURY (Per person) $ <br />A <br />X <br />ANY AUTO <br />ALL OWNED SCHEDULED <br />AUTOS AUTOS <br />BAS59050934 <br />10/1/2018 <br />10/1/2019 <br />BODILY INJURY (Per accident) $ <br />NON -OWNED <br />HIREDAUTOS AUTOS <br />PROPERTY DAMAGE $ <br />Per accident <br />BACEE $ <br />X <br />UMBRELLALIAB <br />X <br />OCCUR <br />EACH OCCURRENCE $ 1,000,000 <br />AGGREGATE $ 1,000,000 <br />B <br />EXCESS LIAB <br />CLAIMS -MADE <br />DED I X I RETENTION $ 10,000 <br />$ <br />USA59050934 <br />10/1/2018 <br />10/1/2019 <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY Y / N <br />X I PER OTH- <br />STATUTE ER <br />.. <br />E.L. EACH ACCIDENT $ 1,000,000 <br />A <br />ANY PROPRIETOR/PARTNER/EXECUTIVE <br />OFFICER/MEMBER EXCLUDED? ❑ <br />(Mandatory in NH) <br />If yes, describe under <br />DESCRIPTION OF OPERATIONS below <br />N / A <br />XWS59050934 <br />10/1/2018 <br />10/1/2019 <br />E.L. DISEASE - EA EMPLOYEE $ 1,000,000 <br />E.L. DISEASE - POLICY LIMIT $ 1,000,000 <br />C <br />ERRORS 6 OMISSIONS <br />SP1022743G <br />10/1/2018 <br />10/1/2019 <br />LIMIT 1,000,000 <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 CG88100413 attached as required by written contract. <br />REVIEWED BY: EUNICE HEREDIA (PG OF ) <br />VII <br />CERTIFICATE HOLDER CANCELLATION <br />ZKekula@santa-ana.org <br />City of Santa Ana <br />20 Civic Center Plaza, M-43 <br />Santa Ana, CA 92702 <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 />ica Hornaday/ERICA v1IWa <br />All rinhtc racar rarl <br />ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD <br />INS025 (201401) <br />