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Ak R�' CERTIFICATE OF LIABILITY INSURANCE 7x(323// 8 YY)
<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 have ADDITIONAL INSURED provisions or be
<br />endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A
<br />statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
<br />PRODUCER y� p �.,,/
<br />Aon Risk Services Inc of Florida �`il) AC it ii" 3 1 i' w`Y
<br />CONTACT
<br />NAME: Aon Risk Services, Inc of Florida
<br />1001 Bricker Bay Drive, Suite #1100
<br />Miami, FL 33131-4937 11``
<br />"p- A d'J.O IS'Le "3 t
<br />PHONE
<br />AIC No Ext); 800-743-8130 A/C No): 800-522-7514
<br />EMAIL
<br />ADDRESS: ADP ,COI.Centerr Aon.com
<br />INSURER(S) AFFORDING COVERAGE NAIC#
<br />INSURER A; American Home Assurance Co. 19380
<br />INSURED yy -_•^ g„�r,�
<br />INS TolalSouroe OE IV, Inc �`t'1A ®1 A nG
<br />INSURER B:
<br />INSURER C:
<br />Miami, FL 331Dme-„-,o, ypV�
<br />!"e i'"W
<br />INSURER D:
<br />UCIF
<br />p
<br />Keyser Marston Associates, Inc. ')66 11 0
<br />1299 Fourth Street, Suite 400 p�
<br />San Rafael, CA 94901 i V'
<br />INSURER E :
<br />INSURER F:
<br />COVERAGES CERTIFICATE NUMBER: 1873463 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. LIMITS SHOWN ARE AS REQUESTED.
<br />INSIR
<br />LTR
<br />TYPE OF INSURANCE
<br />ADDL
<br />INSR
<br />SUBR
<br />WVO
<br />POLICY NUMBER
<br />POLICY EFF
<br />MMIDDIYVYV
<br />POLICY EXP
<br />MMIDDIYYYV
<br />LIMITS
<br />040!7. GAk ErIC daily,, QJLC o
<br />COMMERCIAL GENERAL LIABILITY
<br />EACH OCCURRENCE $
<br />CLAIMS -MADE ❑ OCCUR
<br />DAMAGE TO RENT
<br />PREMISES Ee occurrEDence $
<br />MED EXP (Any one arson $
<br />PERSONAL &ADV INJURY $
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />POLICY F]PROJECT ❑ LOC
<br />GENERAL AGGREGATE $
<br />PRODUCTS - COMPIOP AGG $
<br />$
<br />OTHER
<br />AUTOMOBILE
<br />LIABILITY
<br />COMBINED e E LIMIT
<br />Ea awident $
<br />BODILY INJURY Perperson) $
<br />ANY AUTO
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />BODILY INJURY Per accident $
<br />HIRED NON -OWNED
<br />AUTOS ONLY AUTOS ONLY
<br />PROPERTY DAMAGE
<br />Per accitlent $
<br />UMBRELLA LIAR
<br />OCCUR
<br />EACH OCCURRENCE $
<br />AGGREGATE $
<br />EXCESS LIAR
<br />CLAIMS -MADE
<br />DEC RETENTION $
<br />A
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY YIN
<br />WC 026181717 CA
<br />01/01/18
<br />07/01/18
<br />X PER OTH-
<br />STATUTE ER
<br />ANY PROPRIETOMPARTNERIEXECUTIVE
<br />OFFICER/MEMBER EXCLUDED?
<br />NIA
<br />X
<br />E.L. EACH ACCIDENT S 2,000,000
<br />E.L. DISEASE - EA EMPLOYEE $ 2,000,000
<br />(Mandatory In NH)
<br />If yes, describe under
<br />EL.DISEASE -POLICY LIMIT 1 5 2,000,000
<br />DESCRIPTION OF OPERATIONS below
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
<br />See attached Certlflcale Holder Cancellation Notice.
<br />All worksite employees working for KEYSER MARSTON ASSOCIATES, INC„ paid under ADP TOTALSOURCE, INC's payroll, are covered under the above stated policy,
<br />WAIVER OF SUBROGATION IN FAVOR OF CITY OF SANTA ANA ITS OFFICERS, OFFICIALS, EMPLOYEES, AGENT, REPRESNTATIVES AND VOLUNTEERS AS RESPECTS OF JOB PERFORMED BY
<br />KEYSER MARSTON ASSOCIATES, INC. AS REQUIRED BY WRITTEN CONTRACT.
<br />CERTIFICATE HOLDER CANCELLATION
<br />City of Santa Ana
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />Executive Director of CDA
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL
<br />BE DELIVERED IN
<br />20 Civic Center Plaza M-25
<br />Santa Ana, CA 92701
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />AUTHORIZED REPRESENTATIVE
<br />040!7. GAk ErIC daily,, QJLC o
<br />/
<br />odOfL#da
<br />© 1988-2015 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
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