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A`OPRO CERTIFICATE OF LIABILITY IN$IJRANCE DATE(MM/DD/YYYV)
<br />10/2/2019
<br />THIS CERTIFICATE; IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS N,O 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 po(1cy(ies) must be endorsers, If SUBROGATION 15 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 C N ACT -
<br />NAMEa Certificate ❑epWiment _
<br />Cavignac & Associates PHONE
<br />450 B Street, Suite 1a00 Wc.Nc.E s):619-744-0574 It N�kB19-234-8601
<br />E-MAIL
<br />San Diego CA 92101 ADDRESS: certlficatesoa cavignac.com
<br />INSURERfSI AFFORDING COVERAGE NAIC R
<br />INSURER.A : Valley Forge Insurance Company 20508
<br />INSURED NV51NCO-01 INSURER.9__ Continental Casualty Co. 2044:3
<br />NV5, Inc.
<br />163 'Technology Drive Suite 100 INsuR R c : Continental Insurance Campari� 35289
<br />- - ---------._... —
<br />Irvine, CA 92618 INSURER_0:: National Fire Ins. Hartford. 20478
<br />INSURER.E: Berkley Insurance Company 326D3
<br />INSURER F
<br />/ n\ .Af%cc !`CDTICl/`ATC AIII11n92CD• 1 )%gA4RA'11 RFVIC1f1N M1I1VIRFR-
<br />1-1 IIS IS 1-0 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 />NTTYPEOFINSURANCE ADDL BUBR P�POLTCY EXP LIMITSH WVD p0 CV N BER M4L/ �
<br />A X COMMERCIAL GENERAL LIABILITY Y
<br />6057040530
<br />5/1/2019
<br />5/1/2020
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />j _ X -'
<br />CLAIMS-MADI=. OCCUR
<br />'f]A Ai3E i'i REH?Ep
<br />PREMlS55.[999F.grr@O�j..
<br />$ 1.000,000
<br />$ 15,000
<br />X Cross t lab/Sevin
<br />MED EXP lAny one parson)
<br />PERSONAL & ADV INJURY
<br />X $0 Deductible _ _ _ J`
<br />$ 1,000.000
<br />GENERAL AGGREGATE
<br />$ 2,000,000
<br />GFN'I_ AGGREGATE LIMI1 APPLIES PER: 1
<br />PRODUCTS - COMP/OP AGG
<br />$ 2,000,000
<br />POLICY X • PREcr O LOc
<br />J
<br />I.Stop Ga L,abilil
<br />OTHER
<br />$ 1.000,000
<br />11 AUTOM013ILL LIABILITY Y 6057040575
<br />5/1/2019
<br />5/1/2020
<br />{ BIN , SINGLE LJ $
<br />... . ...--- - T - 11000 000 - - - - --
<br />x ANY AU ID
<br />BODILY INJURY (Per person) $— —
<br />AI fjwNf-❑ SCHEDULED
<br />BODILY INJURY (Per accident) s
<br />Autos ADTDS
<br />NON -OWNED
<br />—1--- --
<br />PRUPEriTYf7AMAt,E $
<br />11ALD AU10S AU1OS
<br />Per Ruddantl _
<br />$
<br />C X UMBRELLA LIAB X OCCUR
<br />i
<br />CUE6076054554
<br />5/1/2019
<br />5/1/2020
<br />EACH OCCURRENCE
<br />$ 20 000,000
<br />AGGREGATE
<br />EXCESS LIAR
<br />i— _ t CLAIM5•1MAD1P•
<br />I
<br />$ 20,000,000
<br />DI-D X REIENTION$
<br />f
<br />$
<br />D WORKERS COMPENSATION
<br />WC6057040558
<br />5/1/2019
<br />5/1/2020
<br />X PER CITH.
<br />STATUTE
<br />_
<br />AND EMPLOYERS' LIABILITY YIN
<br />ANV PRDIII21ETOR/PARTNER/EXECUTIVE 1�;,�
<br />E, L. EACH ACCIDENT
<br />$.1,000.000
<br />Of FICER/MI=MDFR EXCLUDED? NIA
<br />(Mandatory in NH)
<br />E.L. DISEASE - EA EMPLOYEE
<br />t
<br />$ 1,000,000
<br />$ 1,000,000
<br />If yes, doscnbe Under
<br />DG.SCRIP HON 01- OPERATIONS below
<br />E.L. OISEASE -POLICY LIMIT
<br />L Professional/ Pollution Liability
<br />AEC902912003
<br />5/1/2'019
<br />5/1/2020 Each Claim $10,000,000
<br />Aggregate $20,000,000
<br />1
<br />pG.5CRIPT'IQN OF OREFiATIONS I LOCATIONS IVElilCLES (ACORD 101, Addltlenal Remarks Schedule, may be attachud If more space Is required)
<br />Re- On -Call Water Resources. Additional Insured coverage applies to General Liability and Automobile Liability for City of Santa Ana, its officers., employees,
<br />agents and representatives per policy form. Excess/.Umbrella pollcy follows form over underlying policies: General Liability, Auto Liability & Employers Liability
<br />(additional Insured and walver of subrogation apply). Professional Llability - Claims made form, defense costs Included within limit. Primary coverage applies to
<br />General Llabilily and.Autemobile Llabilily per policy form. If the insurance company elects to cancel or non -renew coverage a 30 days written notice of such
<br />cancellation or nomenewai Y411 be provided and 10 days for nonpayment of premium.
<br />REVIEWED & APPROVED
<br />r ■ 0 ITWT+T&TA
<br />I.LKllrl4 Fi1C r-1VLUCK �--C/1"L1�4 LLLMIIVrY
<br />LD ANY OF
<br />M
<br />019 SUEXPIRATIIONH DATE ABOVE
<br />THEREOF, NOTICE POLICIES WILLL CBE C f7rHEDELIVERED IN
<br />City of Santa AnaELLED BEFORE
<br />CORDANCE WITH THE POLICY PROVISIONS,
<br />Risk Management Division FRANCINE R. VILLAR
<br />20 Civic Center Plaza, 4th Floor ORIZE5REPRESENTATIVE
<br />Santa Ana CA 92702
<br />U 1988-2014 ACUKD CUKPUKA I ION. All rlgnts reserves.
<br />ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD
<br />
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