|
ACOR" CERTIFICATE OF LIABILITY INSURANCE
<br />DATE(MM/DD/YYYY)
<br />5/25/2025
<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(ies) must have ADDITIONAL INSURED 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 on
<br />this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
<br />PRODUCER
<br />Alliant Insurance Services, Inc.
<br />353 N Clark St 11th FI
<br />IL 60654
<br />CONTACT
<br />Jordan Laeyendecker
<br />PHONE FAX
<br />A/c No EXt: (A/C, No):
<br />E-MChicago
<br />ADDRESS: Jordan. Laeyendecker@alliant.com
<br />INSURER(S) AFFORDING COVERAGE
<br />NAIC #
<br />INSURERA: Arch Insurance Company
<br />11150
<br />License#: OC36861
<br />INSURED WALSCON-04
<br />INSURERB: Arch Indemnity Insurance Compa
<br />30830
<br />Walsh Construction Company II, LLC
<br />1260 Corona Pointe Court Ste 201
<br />INSURERC: Starr Indemnity & Liability Co
<br />38318
<br />INSURERD:
<br />Corona, CA 92879
<br />INSURER E :
<br />INSURER F :
<br />COVERAGES CERTIFICATE NUMBER:508065786 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.
<br />INSR
<br />LTR
<br />TYPE OF INSURANCE
<br />ADDL
<br />INSD
<br />SUBR
<br />WVD
<br />POLICY NUMBER
<br />POLICY EFF
<br />MM/DD
<br />POLICY EXP
<br />MM/DD
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERALLIABILRY
<br />Y
<br />Y
<br />41PKG8901919
<br />6/1/2025
<br />6/1/2026
<br />EACH OCCURRENCE
<br />$2,000,000
<br />CLAIMS -MADE � OCCUR
<br />PREMISES DAMAGE TO
<br />ccurrence
<br />PREMISES Ea occurrence)
<br />$ 1,000,000
<br />MED EXP (Any one person)
<br />$ 25,000
<br />PERSONAL & ADV INJURY
<br />$ 2,000,000
<br />GEN'L
<br />AGGREGATE LIMIT APPLIES PER:
<br />GENERAL AGGREGATE
<br />$ 4,000,000
<br />POLICY � PRO- � LOC
<br />PRODUCTS - COMP/OP AGG
<br />$ 4,000,000
<br />$
<br />OTHER:
<br />A
<br />A
<br />AUTOMOBILE
<br />LIABILITY
<br />ANY AUTO
<br />41 PKG8901919
<br />41CAB8902019
<br />6/1/2025
<br />6/1/2025
<br />6/1/2026
<br />6/1/2026
<br />COMBINED SINGLE LIMIT
<br />Ea accident
<br />$ 5,000,000
<br />X
<br />BODILY INJURY (Per person)
<br />$
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />BODILY INJURY (Per accident)
<br />$
<br />FIR ER DAMAGE
<br />Per accident
<br />$
<br />HIRED NON -OWNED
<br />AUTOS ONLY AUTOS ONLY
<br />L
<br />$
<br />A
<br />UMBRELLA LAB
<br />EXCESS LAB
<br />X
<br />OCCUR
<br />CLAIMS -MADE
<br />Y
<br />Y
<br />41UFP1992102
<br />1000588415251
<br />6/1/2025
<br />6/1/2025
<br />6/1/2026
<br />6/1/2026
<br />EACH OCCURRENCE
<br />$5,000,000
<br />X
<br />AGGREGATE
<br />$ 5,000,000
<br />DED RETENTION $
<br />2nd Layer Excess
<br />$ 5,000,000
<br />B
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY Y / N
<br />ANYPROPRIETOR/PARTNER/EXECUTIVE
<br />44WCI8937512
<br />6/1/2025
<br />6/1/2026
<br />X PER OTH-
<br />STATUTE ER
<br />E.L. EACH ACCIDENT
<br />$ 1,000,000
<br />OFFICE R/MEMBER EXCLUDED? FNN]
<br />N /A
<br />E.L. DISEASE - EA EMPLOYEE
<br />$ 1,000,000
<br />(Mandatory in NH)
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE - POLICY LIMIT
<br />$ 1,000,000
<br />Tu Tran
<br />Nguyen I
<br />igitally signed
<br />Y.guyen n
<br />uyen
<br />ate: 2025.08.19
<br />4:10:39-07'00'
<br />APPROVED
<br />By Tu Tian Nguyen at 2:09 pm, Aug 19, 2025
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required)
<br />RE: Lease Agreement between The City of Santa Ana and Walsh Construction Company II, LLC for use of property located at 1000 East Santa Ana Boulevard
<br />in the City of Santa Ana - Santa Ana Regional Transportation Center (SARTC), suite 200 and portions of the parking area not presently occupied. Walsh
<br />Project: OC Streetcar Construction - Project IFB 7 - 1904, Job No.: 218132.
<br />City of Santa Ana, its officers, employees, agents, volunteers and representatives are named as Additional Insureds with respect to General Liability and
<br />Umbrella/Excess Liability if required by written contract. General Liability and Umbrella/Excess Liability are primary and any other insurance maintained by the
<br />Additional Insured is excess and non-contributory. Waiver of Subrogation applies to General Liability, Umbrella/Excess Liability if required by written contract.
<br />General Liability includes Severability of Interests / Cross Liability.
<br />Fire Legal Liability is part of the Damage to Rented Premises sublimit under the General Liability policy.
<br />CERTIFICATE HOLDER CANCELLATION
<br />City of Santa Ana
<br />Public Works Agency
<br />Attn: Executive Director of
<br />Public Works Agency
<br />20 Civic Center Plaza (m-21)
<br />Santa Ana CA 92701
<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 />AUTHORIZED REPRESENTATIVE
<br />© 1988-2015 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
<br />
|