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Home My WebLink AboutRBF CONSULTING 5AINSURANCE NOT ON FILE MAYOR WORK MAYWT PROCEI—All MAYOR OR PRO TEM Miguel A. Pu CLERK OF COUNCII .a EM Vincent F. Sarmlanto C COUNCILMEMBERS DATE: J''I J 1 An etica Arrazcua 9 P. David Benauidas Michele Martinez Roman Rayne Sal Tinalero CITY OF SANTA ANA PUBLIC WORKS AGENCY 20 Civic Center Plaza M -36 a P.C. Box 1988 M -36 Santa Ana, California 92702 WWw.santa -ana org April 30, 2015 RBF Consulting Cindy Miller, P.E. 14725 Atton Parkway Irvine, CA 92615 Re: Consultant Agreement with RBF Consulting "Extension" Dear Ms. Miller: A- 2014- 130 -01 Pursuant to Agreement No. A -2014 -130, entered by RBF Consulting, a company of Michael Baker International, LLC and the City of Santa Ana, dated June 3, 2014, Section 4 "Term ", the time period of said Agreement is hereby extended for an additional one (1) year period, through June 30, 2016. The insurance certificates are required to be extended and/or renewed to cover this extension. All other terms and conditions of said Agreement remain unchanged and in ftdt force and effect. If you have any questions regarding this matter, please contact Rudy Rrtsas in the Public Works Agency at 714 -647 -3379. Sincerely, sw" Fred Mou aviporir Executive Director Public Works Agency APPROVED AS TO FORM: Sonia R. Carvalho cc: Clerk of the Council CITY OF SANTA ANA David Cavazos City <nag ATTEST: Maria D. Huizar Clerk of the Council SANTA ANA CITY COUNCIL Miguel A. Pulitlo Vincent fi.5armienlo I Michele MRM,we Angelico Amnzcua P, David eenavides Roman Rayne Sal Tmajero Mayor I Mayor Pro Tem. Ward i Word Ward Word I Words Ward M.pytilQo'o�senia -sna orn i yaffaveniola�santaano orq i RAMertir a n +a�g I AAcr,�uars3sani- v! e3e'a�aanta- ane-ap I RRS i� I - - r9 U.-a---mm aMa- Arm w° A- 2014 - 130 -01 CERTIFICATE OF LIABILITY INSURANCE r DATE.(MMIDDi"YY) 1 09/1212014 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT; If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER AOn Risk Services Central, Inc. Pittsburgh PA Office CONTACT NAME: PHONE (8,66) 283 -7122 FAX 800) 363 -6145 (AiC. No. Ext): AIC. No.): Dominion Tower, 10th Floor 625 Liberty Avenue E -MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE , NAICIR Pittsburgh PA 15222-3110 USA INSURED INSURER A: Liberty Mutual Fire Ins CO 23035 RBF Consultinq PO Box 57057 Irvine CA 92619 -7x57 USA INSURER IS: Lloyd's syndicate No. 2623 AA1128623 INSURER C; Liberty Insurance Corporation 42404 INSURER D: National U'n'ion Fire Ins co of Pittsburgh 19445 INSURER E: DAMAGE TO RENTED PREMISES Ea occurrence $1,000,000 INSURER R MED EXP (Any one person) COVERAGES CERTIFICATE NUMBER: 570055112727 REVISION NUMBER. THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. Limits shown are as requested INSR LTR TYPE OF INSURANCE INSO WVD POLICY NUMBER MM1DD MMf66!'YYl"M LIMITS A X COMMERCIAL GENERAL LIABILITY TB EACH OCCURRENCE ....$7,000,000 CLAIMS -MADE ' OCCUR DAMAGE TO RENTED PREMISES Ea occurrence $1,000,000 X. MED EXP (Any one person) _ $5,000 Contractual X BFPD', XCU PERSONAL & ADV INJURY $2,000,000 CENT AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $4,000, 000 POLICY E PRO- � LOC JECT PRODUCTS - COMPfOP ACC...... S4,000, 000 OTHER'. A AUTOMOBILE LIABILITY 000/2014 08/30/7015 COMBINED SINGLE LIMIT [Ea accident) 51,000,000 BODILY INJURY ( Per person) X ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS X HIRED AUTOS X NON -OWNED AUTOS BODILY INJURY (Per accident) PROPERTY DAMAGE. tPer accident. D X UMBRELLA LIAR X OCCUR BE018742918 08/30,,!2014 08 ✓30/2015 EACH OCCURRENCE S10 „000,000 EXCESS LIAR CLAIMS -MARE AGGREGATE $10 „000,000 DED ' X RETEN710N 514',000 C C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR I PARTNER l EXECUTIVE OFMCERMEI,ABEREXCLUDED? VIA WA768DO04145694 ADS wc7681004145704 06/30/2014 06/30/2014 08✓30/2015 08/36/2015 X PER oTH- STATUTE. ER L.L. EACH ACCIDENT $1,000,000 E L. DISEASE -EA EMPLOYEE $1,000,000 (Mandatory in NHI WI If yes, describe under f3ESCRtlPTI0 N OF OPERATIONS below E.L. DISEASE- POLICY LIMIT 51.,000,000 B E &O-PL °Primary QC1402675 06 ✓30/2014 08/31/2015 Per Claim ss,000,000 Professional & Pollution Aggregate 5s,aa0,(a00 SIR applies per policy ter s & condi ions DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Re On -call Water Resource Engineering Services. The City of Santa Ana and its officers, employees, agents, volunteers, and representatives are included as Additional insured on a Primary and Non - Contributory basis, in accordance with the policy provisions of the General Liability policy. CERTIFICATE HOLDER CANCELLATION i SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE. THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City Of Santa Ana, AUTHORIZED REPRESENTATIVE 20 Civic center Plaza (M -30) p P.O. Box 1988 � tiMi� �,'i aatz Santa Ana CA 97.702 USA 01988 -2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD IL IL w SJ m c 0) '6 us Z3 CS S 0 Z W m u w_ t O) (.7 23320120014,1600005 'THIS ENDORSEMFISIT CHANCF-STHI', POLICY. PLEASE MAD IT CAREFULLY, l3IA,NKF-,TAI)DII'ZONALINSUREI.) This rudvrscrneo; modi6cs insurance provideri ulider 111, f,11owb1g; CONIA121kCIAL GEZ'NUMAI, LT.%BILITY SECTION I - WI-10 IS ANIIINSURED is Rmraded to includc as ati insiticel 3oy person oz or,mnization for wbom you lmvv� ,1p,7,rccd in wriling TO provide li2Nli;y illsumice. But: -nip, inskmnce ;Movid1ml by- this wtwadrnc a: 1, Applies only to '%o6ilv injury" or "PrOpelTy (-L) "your v,,ork" or 0>) przm-;rs or mber propeny ownt,,cl by or reo ed 10 YOU', 2. Applies ojity to covcrage and mttvmi-itn firniis of' msufaircc6 rcquire8 bF ihe wr iwan agrttmenj, lout in 110 ev(,,ni crxceec]s n1her tile Scope of coverap or tile limi(e, of ii1surance provided by dtis policy, and 3, Does not :IpyAy to any pmqon or organi�ation for whorn you have procuitdqcpirale liabilill iazstnsnce whilf, such insuranrc is in effect, T%attiltss OFW41r6er the scopc of coverage or limlis of insurance of this policy cxtced tbosr, of such ot1wrilismance or whether such other irlsul2ncc is valid and collt.rtiblr.. 1'ht follDwing, Provisions also apply; I %1Iwie the applicable sy-iiitcn igrttintwi reqta rcs the ln6mcd to provide. liability insounoz on a pritrpty, , mccc5s, comiugm, or any othIl basis, tilin poliq will opply %ol0y on the 13asis rrquixed by such 'writ(CIZ Agrecinclit and llem 4. Other Iftsurallocof 51,"C"'ON TV Of this policy will not 211131Y, 2, \Nq-CIt dW 0J-)PlJC3WC WJ:iJtrn Jgrtmont dots I-lot -,Peciry on what Im-Sil tlae li slstitity insuranct 'WlApply, the provi5ioos of loan 4, OdIfr Insur-jacc Of SEC 71104N IV of this poky will govern. 1 3 This cadolswicrit AmIl not apply 10 any person or organiz-ation for arty "bothly ininry" or "propeny dnmagc" if any other .066041al insured mdorse'"I'w'rit On this policy appfirs 10 that Person Or orrarv;.ation "ith reg9rd to the "bodily injury" or Pwricrty darTmAt", 4 If my Other idditioilpl insured cndor5ement applies to tiny pct son or orginiz,ition and you arc obligjtcd gander wikitm 08r—n-A to providt IitbifiTy i(Isurince OX1.1 plimary, exce--,3, cotaingtnt, or any Other basis for that additional insmud, this Policy lkitll apf)ty solely on the basis required by curb wrimn ogyrternent -ind licm 4. Other Insurincc of SECTION iV of this wicy. Will I)Ot apply, frgirdIcss of whet her the per5on or org2rintion bas avadribir other valid and collectible insunince. If the AppliC-.&IC 'ITen I NVrI does nol spvciig on what hq'if, dir liability apply, the provisiorus Of1wrI4. Oth- Instnance of SECTION IV of this policy mritl govmI, 'mutkO by N, LIBFIRTY MUTUAL Fl RE INSUF(ANCE COMPANY I,T,M;um 5 E,f (Col Sv 1)alc a0 J,Aq No, AwAir Mx�k 3� I. . IN 21 0 01 0 C, 0.13 Expirjfion Pu�c TB2-681-004145-714 ,/� . . . ... . 7 R,k, ( I F1 ;cc and N, 1, 1 —1, inj N", Policy Number TB2- 681-00414 5-714 fmad by 1A RERTY INI UTUAL FIRE I NSURANCE CO l PANY THIS ENDORSEMENT CHANGES TH5 POLICY, PLEASEREAUITCAREFULLY, NOTICE OF CANCEI_L&a ION TO THIRD PARTIES This rnodflfje�j insurance provided as Ihe(oPovhnf4: BUSINESS AUTO COVERAGE PART N40TOR CARRIER COVERAGE PART GAFMGE COVERAG11- PART' TrWCKC-,R5 COVERAGE PART EXCESS AUTOMOBILE LIABILITY INDEMNITY COVERAGE PART SELF-INSORED TRUCKER EXC S$ (JABILITY COVERAGE PART COMMEKIAL GENE RAL LIABJUTY COVERAGE PA1} 4,T EXCESS COMMERCIAL GENERAL LIABILfTY COVERAGE PART PRODUCTSICOMPLEITED OPE RATIONS LlA!3fLITY COVERAG E PART LIQUOR LMILITY COVERAGE PART COMMCACIAL LIABILITY -UMBRELLA COVERAGE FORM Schurfule NaMe of Other Pemon(s) I Email Address or mailing Number address: 'Per sche on file with [he compariv, 30 K If we cancel this policy for any reason taffies than swnpayment of premiurn, we vAl noffy the persons or ofqara nr tions shown in the Scheduleabove, VIP will send notice to the email or mailing address listed above at least 10 days, or the number of days fisted above, If any, before the concellation becomes effectlwe- In Ao event does the notice to the Mird party exceed the ncAlr>o to the firs I named Insured,. 6. This advance uoflficatioa of a pending of cov4r;3ge is Intended as 'a CourteFy on!y. Our lailura 10 provide 51jr,4 advance no6fication wil not extend ltm Nfcy cancellalion date nor nuQate camegalion of the polk y. All olijer tprrns.�ind condiljone of this policy remain unchanged. Xoo� im i)� 01 or> I I Cc) 2011 Liberty Mutual Group o(C-jmpanies. AD rights reserve-d. paqss I 0i I Includos owyTiGhted maIerj,31 ()f lrrw,a.mrana e SL �rVjae S Cffir;f", Inc., with jEs Permission. PQliQYt",WrV1b0": AS2-681-004145-724 Issued By, Libert,.y MuLual Fire Insurance, Co, THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endur5emef)t modffias Insurance provided under the folIowinq: BUSINESS AUTO COVERAG E PART mcj-r'OR,CARrUER COVERAG E PART 0- ARAGE COVE RAGE: PART TRUCKERS G()VERAGE PAIN EXCESS AUTOMOS IE LIABILITY INVEMNI"I"Y GOVERfkGE PART SELF -JN; lRED TRUCKER EXCESS LIASiLl I'Y COVERAGE PAPT COMMERCIAL GENERAL LIABILITY COVERAGE PART EXCESS COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUICTSfDOMPLETED CAPE kAIFIONS LIABILITY COVERAGE PART LIQUOR LIABILILF'y COVERAGE PART Schedule Name of 6thor Person(s)[ Email Address r madirig Number Organ izatio n(s): address: Days .� ckiedu`e on file witill 30 the company A. If m.�e carcrral this polk-y for any reason other than noripayment of prep -flum, we will notify the persons or, organizations Phown in the SCirJeLdU8 above. We will send notk;e to the email or maWng address fisted 8b0ve at leasl '10 drays, or the riumber of days listed above, if any, Wore the r-anc0lation become$; effe Ave, sn no ev nl r1ops the riotka e to the third party exceed zhe noike Lo the fks named insured, B. ly. OurfaHi.)re to pmvidr-.,, such .-id vancc notification �&qji not r,tkand the policy cancellation dpte nor negate cmcekikn of the policy, All olhor torrns and cored lions of this policy rewrWn unchantged. WA 99 01 05 11 (0 20,11, 1-113erly mu(mnl Group of Cornp,,ml-m All righto reserved. Page I Of I Inrlude's cnp rigi-qod mmerial of trisul'ance Services 011,10e, InQ Joy- with its permission. d 141 NOTICE OF CANCELLATIONTO THIRD PARTIES A. if we cancel this policy for any reason other than nonpayment of premium, we will notify the persons or organi7ationsshown in the Schedule below, We will send notice to the email or mailing address fisted below at least 10 days, Or Vac=. $1Un1bQr of days listed below, if any, before cancellation becomes effecdjvp. In no event, does the notice to the third party exceed the notice to the first narned insured, B. 'This advance notification of a pending cancellation of coverage Is intended as a courtesy only. Our fadure to provide such advance notification will not extend the Policy cancellation date nor negate canmllation of the policy. Schedule Name of Other Person(s) I Email Address or mailing address; Number Days Notice: Organization(s), Per schedule an file with the 30 company All other lon;Ttii and conditlons of Ns policy remain unchanged- fs,sued by UbE ItY InGurarxe Corpovatioll 2,1814 For aflachmenl Jo Polkly No WA7-68D-004145-694 Prernium $ l"Sued to Michael Baker Corporallon WM 9018 06 11 t")20'11,Lib(Mr,yMLituaiGroup. All Rights Reserved. Page I of 1 Ed, 06/01/2011 154 A Policy Number: OC1402676 LIMITED AUTHORITY TO ISSUE CERTIFICATES OF INSURANCE ENDORSEMENT in consideration of the premium charged, it is hereby understood and agreed as follows, (1') Underwriters authorize Aon the ("Certificate Issuer") to issue Certificates of Insurance at the request or direction of the Assured. It is expressly understood and agreed that, subject to Paragraph (2) below, any Certificate of Insurance so issued shall not confer any rights upon the Certificate Holder, create any obligation on the part of the Underwriters, or purport to, or be construed to, after, extend, modify, amend, or otherwise change the terms or conditions of this Policy in any manner whatsoever- In the case of any conflict between the description of the terms and conditions of this Policy contained in any Certificate of Insurance on the one hand, and the tenns and conditions of this Policy as set forth herein, on the other, the terms and conditions of this Policy as set forth herein shall control. (2) Notwithstanding Paragraph (1) above, such Certificates of Insurance as are authorized under this endorsement may provide that in the event the Underwriters cancel or non-renew this Policy or in the event of a Material Change to this Policy, Underwriters shall mail written notice of such cancellation, non-renewal, or Material Change to such Certificate Holder 30 days prior to the effective date of cancellation, non-renewal, or a Material Change, but 10 days prior to the effective date of cancellation in the event the Assured has failed to pay a premium when due. The Assured shall provide written notice to the Underwriters of all such Certificate Holders, N any, specified in each Certificate of Insurance (I): at inception of this Policy, (ii) 90 days prior to expiration of this Policy, and (iii) within 10 days of receipt of a written request from Underwriters. Underwriters' obligation to mail notice of cancellation, non-renewal, or a Material Change as provided in this paragraph shall apply solely to those Certificate Holders with respect to whom the Assured has provided the foregoing written notice to the Underwriters. (3) It is further understood and agreed that Underwriters' authorization of the Certificate Issuer under this endorsement is limited solely to the issuance of Certificates of Insurance and does not authorize, empower, or appoint the Certificate Issuer to act as an agent for the Underwriters or bind the Underwriters for any other purpose. The Certificate Issuer shall be solely responsible for any errors or omissions in connection with the issuance of any Certificate of Insurance pursuant to this endorsement. (4) As used in this endorsement: (i) Certificate of Insurance means a document issued for informational purposes only as evidence of the existence and terms of this Policy in order to satisfy a contractual obligation of the Assured. (ii) Material Change means an endorsement to or amendment of this Policy after issuance of this Policy by the Underwriters that restricts the coverage afforded to the Assured. All other terms, clauses and conditions remain unchanged. Market Submission - Supplemental Page 38 of 54 OM 2610611 Clauses A�. :Z-oIUf, 1 -1.)C),01 "` xc �.rE1�.T'FICI`E LIABILITY INSURANCE [7ATLIMMlDl7lYY'YY) 09f29f2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: It the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Aon Risk 'Services Central, Inc.. Pittsburgh PA office 'CONTACT N AME: (aCNNo. Ext): (866) 283 - 712X. (800) 363 -0105 Dominion Tower, 10th Floor 625 Liberty Avenue: E -MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE N�AIC tI Pittsburgh PA 15222 -3110 USA INSURED INSURER A: Liberty Mutual Fire Ins CO 2303.5 Michael Baker International, Inc. INSURER B: Liberty Insurance corporation 42404 PU Box 57057 Irvine CA 92619 -7057 USA INSURER C: National Union. Fire Ins CO of Pittsburgh 19445 INSURER D: Lloyd's syndicate No. 2623 AA1128623 INSURER E: $100,000 INSURER F. COVERAGES CERTIFICATE NUMBER: 570059597267 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS„ EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. Limits shown are as requested INSR LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER hIMJDD MMIODIYYYY LIMITS A X COMMERCIAL. GENERAL LIABILITY T9 268100414S715 EACH OCCURRENCE $2, 000, 000 CLAIMS -MADE —OCCUR . DAMAG TO RENTED PREMISES Ea occurrence $100,000 MED EXP (Any one person) S5,000 PERSONAL 8 ADV INJURY $2,000,000 '. GEWL AGGREGGA-T-�E LIMIT APPLIES PER: GENERAL AGGREGATE $4,..000,000 POLICY y X pPRO- �LOC, L_� JECT PRODUCTS - COMPIOP AGG $4,000,000 OTHER: A AUTOMOBILE LIABILITY A52- 681. - 004145 -725 08/30/20155 08/30/2016 COMBINED SINGLE LIMIT Ea accident) $1,000,000 BODILY INJURY ( Per person) : ANY AUTO BODILY INJURY (Per acuderl) ALL OWNED SCHEDULED AUTOS AUTOS JX HIRED AUTOS y( NON - GOWNED AUTOS PROPERTY DAMAGE Per accident C X UMBRELLA LIAR I X I OCCUR. SE033086983 08/30/2015 08/30/2016 EACH OCCURRENCE $10,000700 EXCESS LIAR CLAIMS- MADE AGGREGATE $10,000,000 DED I X RETENTIONS10,000 B B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR I PARTNER! EXECUTIVE OFFICERIMEMBER EXCLUDED? I N C, (Mandatory In NH) L—J NIA wA768D004145775 AOS lNCa6 8100414 5 7 s5 wI 08/30/2015 08/30/2015 08/3072016 013 /so /2' .01Cz X I PER 107H- STATUTE IFR E.L. EACH'. ACCIDENT $1,()00,000 E.L. DISEASE: -EA EMPLOYEE S1,000,000 IE yS6 dcscnbe under DESCRIPTION OF OPERATIONS below E L. DISEASE- POLICY LIMIT S1,000,000 D E &O -PL- Primary QC1502675 08/31/2015 08/31/2016 Per Claim $S,000,000 Professional & Pollution Aggregate $5,000,000 SIR applies per policy ter s & condi ions DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, AddIldonal Remarks Schedule, may be attached if more space Is required) Re: On -call water Resource EngiIneering Services. The City of Santa Ana and its officers, employees, agents, volunteer's, and representatives are included as Additional insured on a Primary and Non -- Contributory basis, in accordance with the policy provisions of the General Liability policy. CERTIFICATE HOLDER CANCELLATION @1988 -2014 A'GOR6D CORPORATION. All rights reserved. ACCORD 25 (2014101) The ACCORD name and logo are registered marks of ACORD Riqz, 2 L'7 Ut uJ cT U w c w a zs a T V t.. �4 a t` Q Z ®f iM t: 0 U II L t $HOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF', NOTICE WILL BE DELIVERED IN ACCORDANCE, WITH THE POLICY PROVISIONS.. City Of Santa Ana AUTHORIZED REPRESENTATIVE 20 Civic Center Plaza (M -:30) PO Box 1998 Santa Ana CA 927021988 USA @1988 -2014 A'GOR6D CORPORATION. All rights reserved. ACCORD 25 (2014101) The ACCORD name and logo are registered marks of ACORD Riqz, 2 L'7 Ut uJ cT U w c w a zs a T V t.. �4 a t` Q Z ®f iM t: 0 U II L t 2122 01 4000077wQ91 Policy Number TB2681004145715 Issued by Liberty Mutual Fire Insurance Co, THIS END ORSEVENT CHANGES THE POLICY. PLEASE READ ITCAREFULLY. This endorsement modifies insurance provided under the following: SECTION 11- WHO 15 ANINSURED is amended to include as an insured any person or organization for whom you have agreed in writing to provide liability insurance. But: The insurance provided by this amendment: 1. Applies only to 'bodily injury or'property damage' arising out of (a) 'your work* or (b) premises or other property owned by or rented to you; Z Applies only to coverage and minimum limits of insurance required by the written agreement, but in no event exceeds either the scope of coverage or the limits of insurance provided by this policy; and 3,- Does not apply to any person or organization for whom you have procured separate liability insurance while such insurance Is in effect, regardless of whether the scope of coverage or limits of insurance of this policy exceed those of such other insurance or whether such other insurance is valid and collectible, The following provisions also apply: 1. Where the applicable written agreem erd requires the insured to provide liability insurance on a primary, excess, contingent, or any other basis, this policy will apply solely on the basis required by such written agreement and Rtm 4. Other Insurance of SECTION IV of this policy will not apply. 2. Where the applicable written agreement does not specify on what basis the liability insurance will apply, the provisions of Item 4. Other Insurance of SECTION IV of this policy will govern- 3 This endorsement shall not apply to any person or organization for any "bodily injury' or "property damage" if any other additional insured endorsement on this policy applies to that person or organization with regard to the *bodily injury' or *property damage'. 4. If any other additional insured endorsement applies to any person or organization and you are obligated under a written agreement to provide liability insurance on a pnimary, excess. contingent or any other basis for that additional insured, this policy will apply solely on the basis required by such written agreement and item 4. Other Insurance of SECTION IV of this policy will not apply, regardless of whetherthe person or organization has available other valid and collectible insurance. If the applicable written agreement does not specify on what basis the liability insurance will apply, the provisions of item 4. Other Insurance of SECTION rV of this policy will govern. LN 2001 0605 1 +9330 3 00080 60 0069 Policy Number T3326810041,45715 Issued by IJBERTY MUTUAL, FIRE INSURANCE COMPANY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: BUSINESS AUTO COVE-RAGE PART MOTOR CARRIER COVERAGE PART GARAGE COVERAGE PART TRUCKERS COVERAGE PART EXCESS AUTOMOBILE LIABILITY INDEMNITY COVERAGE PART SELF-INSURED TRUCKER EXCESS LIABILITY COVERAGE PART COMMERCIAL GENERAL LIABILITY COVERAGE PART EXCESS COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART COMMERCIAL LIABILITY — UMBRELLA COVERAGE FORM .. ............. - ------ L Schedule Name of Other Person(s) I Email Address or mailing address: Number Days Notice, organization(s.): Per Schedule on file with the Pr r Schedule on file with the Company 30 Company .. . .......... ............. . . .. - ------ A. If we cancel this policy for any reason other than nonpayment of premium, we will notify the persons of organizations shown in the Schedule above. We will send notice to the email or mailing address listed above at least 10 days, or the number of days listed above, if any, before the cancellation becomes effective. In no event does the notice to the third party exceed the notice to the first named insured. This advance notification of a pending cancellation of coverage is intended as a courtesy only, Our failure to provide such advance notification will not extend the policy cancellation date nor negate cancellation of the policy. All other terms and conditions of this policy remain unchanged. LIM 99 01 05 11 0x'011 Liberty Mutual Group of Companies. All rights reserved, Page I of 1 Includes copyrighted material of Insurance Services Office, Inc., with its permission. cl, 21820140000-1-500109 Policy Number AS-2-6,31-00/4145-725 Issued By: Liberty Mutual rire insurance Co, [LIN NE41; FL NOTICE OF CANCELLATION TO THIRD PARTIES This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE PART MOTOR CARRIER COVERAGE PART GARAGE COVERAGE PART TRUCKERS COVERAGE PART EXCESS AUTOMOBILE LIABILITY INDEMNITY COVERAGE PART SELF-INSURED TRUCKER EXCESS LIABILITY COVERAGE PART COMMERCIAL GENERAL LIABILITY COVERAGE PART EXCESS COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART Schedule A. If we cancel this policy for any reason other than nonpayment of premium, we will no* the persons or organizations shown in the Schedule above by email as soon as practical after notifying the first Named Insured, B. This advance email notification of a pending cancellation of coverage is intended as a courtesy only. Our failure to provide such advance notification will not extend the Policy cancellation date nor negate cancellation of the policy, Afl other terms and conditions of this policy remain unchanged. LIM99 02 0811 0 7-011, Liberty Mutual Group of Companies. All rights reserved, Page 1 of 1 Includes copyrighted material of Insurance Services Office. Inc, with Its permission. 2"CA 4, t A. If we con"-I this podcy for any reason other than nonpayment of prernium, we will notify the persons or organizations shown in the Schedule below. Wo will send notice to the email or malting address listed below at least 10 days, or the number of days listed below, if any, befare cancellation ba=-nes effective. In no event does the notice to the third party exceed the notice to the fin ns I riamed insured. B. PiN advance nolirication of to Pending cancellation of coverage Is Intended as a courtesy only, Our failure to provide such advance notification will not extond the policy canceHatron data nor negate cancellation of the policy, Schedule Name of Other per. on(s) I Email AddImss or mailing address: Number Days Notice� Organization( s): Per scbedule on file with the 30 company All other terms and conditions, of this policy remain unchanged. lfwued by Liberty 1113WBnOO Co artitiun 21814 RvalUxhmen! W Policy Not WA7081)004145775 Pro nium S lasur'd to Ukhad Onker WM 90 is 06 11 c! 2011, Libeylly Mutual Group. All Rightw Reserved. Page I of I Ed. OWGU2011