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Y) /220010 //003 3 ACORDM CERTIFICATE OF LIABILITY INSURANCE 088DATE 10 PRODUCER 0757776 1-800-877-4560 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION HUB International Insurance Services Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR P.O. Box 4047 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Concord, CA 94524 INSURERS AFFORDING COVERAGE INSURED INSURER A:OneBeacon America Insurance Co. Harris & Associates Inc. Attn: Susan Mandilag INSURERB:Wausau Underwriters Insurance Company 1401 Willow Pass Road, Suite 500 -"?L l Z INSURER C: Colony National Insurance Company Concord, CA 94520 INSURER D: Travelers Property Casualty Cc of Amer. INSURER E: Continental Casualty Company COVERAGES 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. IN LTR SR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE PODATE fMWDDNY) LICY EXPIRATION LIMITS A GENERAL LIABILITY 7180096900004 08/01/10 08/01/11 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY FIRE DAMAGE (Any one fire) $ 1, 000, 000 - CLAIMS MADE EK OCCUR 1 MED EXP (Any one person) $ 10,000 X "X" "0" "U" PERSONAL & ADV INJURY $ 1,000,000 X Separation of Insureds GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,000 POLICY X PRO LOC B AUT OMOBILE LIABILITY ASJZ91455034010 08/01/10 08/01/11 COMBINED SINGLE LIMIT X ANY AUTO (Ea accident) $ 1,000,000 ALL OWNED AUTOS APPROVED AS TO FO RM BODILY INJURY SCHEDULED AUTOS (Per person) $ X HIRED AUTOS ?,tm- 6;?.. •._. ? BODILY INJURY X NON-OWNED AUTOS ??' +_.! 1-1: L1. ..? I:SL[ s?12 (Per accident) $ °'?:??•.Id,I malty At?O Rey PROPERTY DAMAGE - tVj (Per accident) $ GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ r AUTO ONLY: AGG $ C EXCESS LIABILITY AR6460401 08/01/10 08/01/11 EACH OCCURRENCE $ 10,000,000 X OCCUR FICLAIMS MADE AGGREGATE $ 10,000,000 R DEDUCTIBLE $ RETENTION $ $ D WORKERS COMPENSATION AND PJUB8166N36A10 08/01/10 08/01/11 X WCSTATU I FR EMPLOYERS' LIABILITY E.L. EACH ACCIDENT 1, 000, 000 $ E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE- POLICY LIMIT $ 1,000,000 E OTHER Professional Liability AEA113822501 08/01/10 08/01/11 Per Claim: $10,000,000 Aggregate: $15,000,000 Ded. Each Claim: $ 150,000 DESCRIPTION OF OPERATIONS/LOCATIONSJVEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS •• Workers Compensation policy excludes monopolistic states ND, OH, WA, WY. General & Auto Liability Additional Insured status granted, if required by written contract/agreement, per attached forms AS00010 0198 & CA2048 0299. JRe: Bristol Street Widening Project - Phase I (A-2006-192) (HA #062-0412.01) CERTIFICATE HOLDER ADDITIONAL INSURED; INSURER LETTER: CANCELLATION Ten Day Notice for Non-Payment of Premium 062-0412.01 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION Attn: Sheri Barkley City of Santa Ana DATE THEREOF, THE ISSUING INSURER WILL E*MX f4 MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, 9=rM=KX05=670IX=KX Public Works Design Engineering Xppgffi3L8C]0ffi?SA477iGGR7t7FxN iGAC14XDRIDIONAI9UF#F]4?[GCKK]5iCffiP[X 20 Civic Center Plaza Xis g yagJCXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX Santa Ana, CA 92701 AUTHORIZED REPRESENTATIVE USA qqn? ACORD 25-S (7/97) dgarcia O ACORD CORPORATION 1988 16914403