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ACCPRLY CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY)
<br />03/29r2019
<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 pollcy(les) must have ADDITIONAL INSURED provisions or be endorsed,
<br />If SUBROGATION 15 WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement, A statement on
<br />this certificate does not confer rights to the certificate holder in lieu of such andorsement(s),
<br />PRODUCER
<br />NRME CT Marilyn Hader
<br />The Juban insurance Group LLC
<br />PHONN Ext (225) 291-0405 A10 No : (225) 291.0420
<br />4319 Bluebonnet Blvd
<br />EMAIL @)
<br />ADDRESS; n marl!Y ubaninsurance.com
<br />[NSURER(S) AFFORDING COVERAGE
<br />NAIC A
<br />Baton Rouge LA 70803
<br />INSURERA: Certain Und @ Llcyds of London
<br />AA-1122000
<br />INSURED
<br />INSURER B; Travelers Indemity Co of CT
<br />25682
<br />Utlliworks Consulting, LLC', Utliiworks, LLC ✓
<br />INSURER C ;
<br />2361 Energy Drive, St& 1010
<br />INSURER ❑:
<br />INSURER E i
<br />Baton Rouge LA 70808
<br />INSURER F I
<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 CONTRACTOR 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 />EXCLU$ONSAND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS,
<br />ILTR
<br />TYPE OF INSURANCE
<br />INSD
<br />WV
<br />POLICY NUM3ER
<br />POLICYI=FF
<br />MMlppl`(YYY
<br />POLICY EXP
<br />MMlDDlYYYY
<br />LIMITS
<br />x
<br />COMMERCIAL GENERAL LIABILITY
<br />CLAIMS MADE
<br />EACH OCCURRENCE
<br />$ 2,000,000
<br />OCCUR
<br />PREMISES hacccurrenca
<br />$ 250,pe0
<br />MP EXP (Anyone person)
<br />$ 51000
<br />PERSONAL SIADVINJURY
<br />$ 2,000,000
<br />A
<br />PSH05720413
<br />08108I2016
<br />0810612C19
<br />GEN'LAGGREGATE LIMITAPPLIPS PER
<br />POLICY iC ❑PRO- ❑
<br />LOC
<br />OENERALAGGREGATE
<br />$ 4,000,000
<br />JECT
<br />PRODUCTS •COMPlOPAGG
<br />$ 2,000,000
<br />OTHER;
<br />Employee Benefits
<br />$ 2,000,000
<br />AUTOMOBILE
<br />LIA9ILITY
<br />❑GMa1NED SINGLE LIMIT
<br />Ea accident
<br />$
<br />ANYA 70
<br />BODILY INJURY (Per person)
<br />$
<br />A
<br />AUTOS AUTOS5CHEDLEC
<br />AUTOS ONLY AUTOS
<br />PSH05720413
<br />0810612018
<br />08/06/2019
<br />BODILY INJURYiParacnidenp
<br />$
<br />HIRED NON -OWNED
<br />AUTOS ONLY AUTOS ONLY
<br />x
<br />PROPERTY DAMAGE
<br />Per acddenl
<br />$
<br />Hired And Non-Ownod
<br />$ 1,a00,000
<br />UMBRELLA LIAB
<br />OCCUR
<br />EACH OCCURRENCE
<br />$
<br />AGGREGATE
<br />$
<br />EXCESS LIAB
<br />CLAIMSWADE
<br />bEb I I RETENTION $
<br />$
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY
<br />STATUTE ERH
<br />YIN
<br />E.L.EACHACCIDENT
<br />$ 1000,Oa0
<br />,
<br />l3
<br />ANY PROPRIETORIPARTNERIEXECUTIVE
<br />OFFICERIMEMBEREXCLUDF FNJ
<br />NIA
<br />UB-6J384926-18
<br />10/01/2018
<br />1WIDII2019
<br />E.L. DISEASE - EA EMPLOYEE
<br />$ 1 000,0a0
<br />(Mandatory In NEVI
<br />Ifyes, under
<br />E.L, DISEASE -POLICY LIMIT
<br />$ 1,000,000
<br />IPc
<br />DE5CRIPT30NOF OPERATIONS below
<br />Profeaslonal Liability
<br />Each & Every Claim
<br />$2,000,000
<br />A
<br />Errors & Ommissions
<br />PSF106720413
<br />0810612018
<br />08/0612019
<br />Aggregate
<br />$2,000,000
<br />Deductible
<br />$5,000
<br />OIESCRIPTION OF OPERATIONS f LOCATIONS I VEHICLES (ACORD 101, Addltlonal Remarks Schedule, maybe attached If more space Is required)
<br />CyborlTechnology Liability $2,000,000 Each Claim $2,000,000 Aggregate,
<br />Applicable to Gertirtcale Holder. Blanket Additional Insured, Primary Non -Contributory basis, 30 days nolico of cancellation (10 days for non-payment) and
<br />Wavier of Subrogation included in the General Liab€ilty General Condition wording, If required by written contract. nke c 5 In yf
<br />certificate holderwhen required by written agreement with respects to Workers Compensation. j rttj�
<br />urn i lriC,A Crir}i iJrK i1491A /fir 1 11f
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />City of Santa Ana, The City, Its officers,empioyees agents, volunteers &
<br />ACCORDANCE WITH THE POLICY PROVISIONS,
<br />representatives as addl lnsds
<br />AUTHORIZED REPRESENTATIVE
<br />20 Civic Center Plaza
<br />Santa Ana CA 92701r
<br />j}
<br />J
<br />9
<br />U 1988-2015 ACORD CORPORATION. Ail rights reserved.
<br />ACORD 25 (20161
<br />City Council 18 — 72 11/21/2023
<br />
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