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Digitally signed by Teri
<br />Tori Pierson Pierson
<br />Date: 2022.04.2o 14:42:46
<br />0T00'
<br />JAMIENG-01 SGONZALEZ
<br />Hls" CERTIFICATE OF LIABILITY INSURANCE
<br />oAT12312022
<br />32312022
<br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
<br />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($),
<br />AUTHORIZED
<br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
<br />IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the pOliCy(iss) must have ADDITIONAL INSURED
<br />provisions or be endorsed.
<br />If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement
<br />on
<br />this certificate does not confer rights to the certificate holder in lieu of such endorsements).
<br />PRODUCER License 0 D757776 COGail Schmnk
<br />NAME'NTACT
<br />HUB International Insurance $eNlCee Inc. PHONE "—
<br />PO Box 5345 talc, No In'tr (951) 779-8763 �Wc,. rm (951) 231 2572
<br />Riverside, CA 92517 EADDRESS. cal-cpu@hubintemational.com
<br />INSURERS AFFOROINO EOYERAGE NAIC#
<br />-- — - - -- __-. INMRRA:LandmarkAmerican Insurance Com a 33138
<br />INSURED INSURER a: West American Insurance Co 44383
<br />_
<br />Jamison Engineering Contractors Inc. lusuRERc: RSUI Indemni Com an 22314
<br />SSantaS. Yalea Ana, CA A 92704 INsueenD: State. Compensation Insurance Fund of CaBfomia 35076
<br />Sant --
<br />INSURER E:
<br />. INSURER F:
<br />REVISION NUMBER:
<br />--- __.ES OF^4SURA CE LISTED
<br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED
<br />TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
<br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH
<br />RESPECT TO WHICH THIS
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN
<br />IS SUBJECT TO ALL THE TERMS,
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />INSR
<br />LT TYPE OF INSURANCE
<br />ADDL
<br />SUER
<br />WYD POLICY NUMBER
<br />POLICY EFF
<br />POLICY EXP
<br />M
<br />UNOS
<br />.._.-
<br />A X COMMERCIALGENERALUABILDY
<br />EACH OCCURRENCE
<br />S 1,000,006
<br />CLAIMSAuuDE 0 OCCUR
<br />BOPD Ded: $2,500
<br />NX
<br />X
<br />LHA141851
<br />3121/2022
<br />3f21(2023
<br />DAMAGETO RENTED
<br />s 50,000
<br />0,000
<br />MEDEXP one mon
<br />PERSONAL & ADV INJURY
<br />$ 1,ODD,000
<br />C
<br />GEN'L AGGREGATE UMIT APPUES PER:
<br />I�_ POLICY ❑X P�2P LOC
<br />GENERAL AGGREGATE
<br />2
<br />5 .000+
<br />PRODUCTS- COMPIOP AGO
<br />I B 2.00g,000000
<br />1
<br />OTHER:
<br />i
<br />�S
<br />B AUTOMOBILE LIABILITY
<br />COMBINEDSINGLE LIMB
<br />aamAd
<br />S 1,000,000
<br />X ' O
<br />OWNED
<br />' OWNED —1 SCHEDULED
<br />X
<br />IBAW56573285
<br />3/2112M
<br />I22112023
<br />BODILY INJURY Per ersen
<br />S
<br />BODILY INJURY Per accitlenl
<br />$
<br />AUTOS ONLY AUTOS
<br />X HIRED X
<br />—� -0.5
<br />A pry
<br />PROPERTY DAMAGE
<br />eraccNent
<br />S
<br />XAUI"OS ONLY UT
<br />Camp & Con rX iDetl S1,DD0
<br />EACH OCCURRENCE
<br />AGGREGATE
<br />$
<br />g 5,000,000
<br />S 5,000,000
<br />( UMBRELLA lIAB X OCCUR
<br />X' ExCEss LIAR CLAIM&MADE
<br />NHA253427
<br />3121/2022 1
<br />3/2112023
<br />DELI I X RETENTIONS 0
<br />D ION
<br />S
<br />LSA
<br />ANDWORKERS MPL EMPLOYERS,
<br />AND EMPLOYERS' LIABILRY
<br />ILrr
<br />YIN
<br />X PTR T OTtl-
<br />ANY PROPRIETOR/PARTNERJE(ECUTNE
<br />9FFICE(cry ILME
<br />Nendd nM�R E CW DEDT
<br />NIA
<br />X 903749622
<br />1/1/2022
<br />11112023
<br />E.L EACH ACCIDENT
<br />S 1,000,000
<br />E.L DISEASE -EA EMPLOYE
<br />S 1,000,000
<br />If yes. describe, Under
<br />'DESCRIPTION OF OPERATIONS bebw
<br />E.L DISEASE -POLICY LIMIT
<br />1,000,000
<br />I
<br />DESCRIPTION OF OPERATIONS / LOCATIONS I VEMCLES (ACORD IM, Additional Remarks Schedule, may be attached if mom apace is mgulred)
<br />Excess Liability Policy following underlying policies: GL, Auto, WC Only
<br />RE: On Call Services.
<br />City of Santa Ana, officers, agents, employees, representatives and volunteers are Additional Insured with regard to General Liability when required by
<br />written
<br />contract per the attached endorsement fortes CG2033 04113, CG2037 04/13. Primary & Non -Contributory wording applies with regard to General Liability when
<br />by
<br />required written contract per the attached endorsement form CG2001 12119. Additional Insured with regard to Auto Liability when required by
<br />written
<br />contract per the attached endorsement form AC8543 e6/18. Waiver of Subrogation with regard to Workers Compensation applies when required by written SEE
<br />ATTACHED ACORD 101 I
<br />reoTrerra� ues. ..�..
<br />City of Santa Ana
<br />Risk Management Division
<br />20 Civic Center Plaza
<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 />AUTHORIZEDD REPR�ESERTAME
<br />�AfGt�A �/!l%
<br />A4UKU zL tZU7b/UJ) © 1988-2015 ACORD CORE _`-�- am.Mar,as�.�namUlado F(
<br />The ACORD name and logo are registered marks of ACORD
<br />
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