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<br />CERTIFICATE OF INSURANCE
<br />
<br />CERTIFICATE NUMBER
<br />721047
<br />
<br />PRODUCER
<br />
<br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO
<br />RIGHTS UPON THE CERTIFICATE HOLDER OTHER THAN THOSE PROVIDED IN THE POLICY.
<br />THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE
<br />POLICIES DESCRIBED HEREIN.
<br />
<br />Marsh, Inc.
<br />1166 Avenue of the Americas
<br />New York, NY 10036
<br />Telephone (212) 345-5000
<br />
<br />INSURED
<br />
<br />COMPANIES AFFOPDING COVERAGE
<br />___._.______ - _n,___ _.___________ .._______~~__
<br />COMPANY A: AGCS Marine Insurance Company (Allianz)
<br />COMPANY B: AI South Insurance Co.
<br />COMPANY C: Commerce & Industry Ins Co
<br />COMPANY D: Illinois National Insurance Co.
<br />COMPANY E: Insurance Company of the State of PA
<br />COMPANY F: Nat'l Union Fire Ins Co of Pittsburgh, PA
<br />COMPANY G: New Hampshire Ins. Co.
<br />
<br />SimplexGrinnell, LP
<br />1701 WEST SEQUOIA AVE
<br />ORANGE, CA 92868
<br />United States
<br />
<br />COVERAGES
<br />
<br />
<br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE DESCRIBED HEREIN HAVE BEEN ISSUED TO THE INSURED NAMED HEREIN FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING
<br />ANY REQUIRMENTS, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THE CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE
<br />AFFORDED BY THE POLICIES LISTED HEREIN IS SUBJECT TO ALL THE TERMS. CONDITIONS AND EXCLUSIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY
<br />PAID CLAIMS
<br />
<br />~~-l TYPE OF INSURANCE -
<br />LTR
<br />
<br />POLICY NUMBER
<br />
<br />I
<br />POLICY EFFECTIVE I POLICY
<br />DATE (MM/DDIYY) I EXPIRATION
<br />
<br />LIMITS
<br />
<br />G I GENERAL LIABILITY GL 090-73-63 (Primary GL) 10/1/2009 10/112010 GENERAL AGGREGATE ___ $2,000"000.00
<br /> I~""'~ ""MC PRODUCTS - COMP/OP AGG $2,OQQ,000.00
<br /> ---...J CLAIMS MADE [XJ OCCU PERSONAL & ADV INJURY 1.000,000.00
<br /> OWNER'S & CONTRACTOR'S EACH OCCURRENCE $1,000,000.00
<br /> --------,.'-------.-.- FIRE DAMAGE (Anyone fire) _---.l!..9.00,000.og
<br /> I MED EXP (Anyone person) 10 000.00
<br />F AUTOMOBILE LIABILITY CA 091-93-98 (MA) 10/1/2009 10/1/2010 COMBINED SINGLE LIMIT $1,000,000.00
<br />F X ANY AUTO CA 091-93-97 (VA) 10/1/2009 10/1/2010
<br /> ----._-
<br />F X HIRED AUTOS I CA 091-93-96 (AOS) 10/1/2009 10/1/2010
<br /> X NON-OWNED AUTOS
<br />B WORKERS COMPENSATION AND WC 060-16-8747 (CT,GA,PA,SC) 10/1/2009 10/1/2010 OTHE
<br /> R
<br />C EMPLOYERS' LIABILITY WC 060-16-8741 (FL) 1 0/1/2009 ! 10/1/2010 $2,000,000.00
<br />I EL EACH ACCIDENT
<br />D . THE PROPRIETOR/ WC 060-16-8744 (MI) 10/1/2009 i 10/1/2010
<br />E PARTNERS/EXECUTIVE . WC 060-16-8745 (AR,MA.VA) 10/1/2009 ! 10/1/2010 EL DISEASE-POLICY LIMIT $2,000,000.00
<br />F OFFICERS ARE- I WC 060-16-8742 (OR) 10/1/2009 10/1/2010 EL DISEASE-EACH $2,000,000.00
<br />F WC 060-16-8740 (CA) 10/1/2009 10/1/2010 ---.-
<br />G WC 060-16-8748 (AOS) 10/1/2009 10/1/2010 ---------
<br />G WC 060-16-8743 (TX) 1 0/1/2009 110/1/2010
<br />G WC 060168746 (ND,NY,OH,WA,WI,WY) 10/1/2009 10/1/2010 ---. -...----
<br /> EXCESS LIABILITY ifJA GENERAL AGGREGATE
<br /> -----------.
<br /> OTHER THAN UMBRELLA FORM l\.S 'to to i _____ PRODUCTS - COMP/OP AGG
<br /> ------,._--
<br /> EACH OCCURRENCE
<br /> -------_.-
<br /> UMBRELLA FORM
<br /> ..___._m__
<br />
<br />'OTHER
<br />
<br />
<br />A
<br />A
<br />A
<br />
<br />Builder's Risk/installation/Contract Works
<br />Rental EquipmenUContractor's Equipment
<br />Blanket TranSit
<br />
<br />OC & OCW 91128600
<br />OC & OCW 91128600
<br />OC & OCW 91128600
<br />
<br />5/1/2010
<br />5/1/2010
<br />5/1/2010
<br />
<br />5/1/2011
<br />5/1/2011
<br />5/1/2011
<br />
<br />USD $1.000.000.00 per jobsite
<br />USD $1,000.000.00 per Jobslte
<br />USD $1,000,000.00 per conveyance
<br />
<br />DESCRIPTION OF OPERA TlONS/LOCA TIONSNEHICLES/SPECIAL ITEMS
<br />CITY OF SANTA ANA is named as Additional Insured subject to the conditions of the written contract between the Named Insured and CITY OF SANTA ANA
<br />
<br />Project: Santa Ana Train Station/SARTIC 4-S-10/SG#950323501
<br />
<br />Other Additional Insureds: "The City of Santa Ana, it's officers, employees, agents, and representative are named as additional insured."
<br />
<br />CERTIFICATE HOLDER
<br />
<br />CITY OF SANTA ANA
<br />ATTN: PURCHASING DEPARTMENT
<br />20 CIVIC CENTER PLAZA
<br />SANTA ANA, CALIFORNIA 92701-4010
<br />United States
<br />
<br />CANCELLATION
<br />
<br />SHOULD ANY OF THE POLICIES DESCRIBED HEREIN BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE
<br />INSURER AFFORDING COVERAGE WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER
<br />NAMED HEREIN, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON
<br />THE INSURER AFFORDING COVERAGE, ITS AGENTS OR REPRESENTATIVES, OR THE ISSUER OF THIS CERTIFICATE
<br />
<br />--=-j--'1 ---"\
<br />MARSH USA INC, BY:
<br />David Kong, Casualty Program
<br />
<br />1~ 1v. ~
<br />
<br />Franklin Hallock, Global Marine
<br />Transit Program
<br />
<br />VALID AS OF: 5/4/2010
<br />
<br />For quest.ions regarding t.his certificate contact: Judy Evans (Emai:i: judyevans@simplexgrinnell.com Phone: 714-870-1010 ext 632)
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