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. CERTIFICATE OF LIABILITY INSURANCE DATE(r
<br />l?YYY)
<br />.
<br />k, 3120
<br />10/3120'10
<br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFiCA-rF: HOLDER. THIS
<br />CERTIFICATE DOES NOT AFFI?MA,T,IVEff??YOR?)jNEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED SY THE POLICIES
<br />BELOW, THIS Cr i,tTIMATEI OF It?4t)RDiQG=WOFS NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
<br />REPRESENTATIVi;•& ORbDLfdER, AND THE CERTIFICATE HOLDER.
<br />IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, tho polley(les) must be endorsed. If SU13ROGyATION IS WAIVED, subject to
<br />the terms and condll?ioris of She policy, certai6oolicies may require an endorsement- A statement on this certificate does not confer rights to the
<br />certificate holder iY Ueti of such enddrsem6rit s . _
<br />PRODUCER E.,I-.-- - NQQN1AUf
<br />AME-
<br />Marsh, Inc- PHONE FAX
<br />AIC No F.* - AIC Ne l
<br />1166 Avenue of the Americas -MA
<br />New York
<br />NY 10036 ADDRESS:
<br />, PRODUCER
<br /> CUSTOMER ID A
<br /> INSURER(S) AFFORDING COVERAGE NAIL 9
<br />INSURED INSURER A: AGCS Marine Insurance Company (Allianz)
<br />SimplexGrinnell, LP INSURER B: CHARTIS CASUALTY COMPANY
<br />1701 WEST SEQUOIA AVE INSURER C: Commerce & Industry Ins Co.
<br />ORANGE, CA 92865 INSURER D: Illinois National Insurance Co,
<br />United States INSURER E. Nat'l Union Fire Ins Co. of Pittsburgh, PA
<br /> INSURER F: New Hampshire Ins. Co,
<br />COVERAGES CERTIFICATE NUMBER: 743142-A REVISION NUMBER-
<br />THIS I$ 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 REOUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT 70 WHICH THIS
<br />CERTIFICATE MAY 6E ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
<br />EXCLUSIONS AND CONDITIONS 05 SUCH POLICIE$_ LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />rLTR R
<br />LT TYPE OF IN$URANCr: AD?L SUER POLICYNUMBER MNPOLICY IDDIY E YYY MM?DIYYYY LIMITS
<br />F GENERAL LIABILITY GL 4360884 (Primary GL) 101112010 10/1/2011 EACH OCCURRENCE $1,000,000.00
<br /> X COMMERCIAL GENERAL LIABILITY PREMISES Ea aca=na: S1.000,00D.00
<br />
<br /> CLAIMS-MADE L:L%?J OCCUR MED EXP Any ona person $10.000.00
<br /> OWIJER'8 8 CONTRACTOR'S PERSONAL & ADV INJURY 31.000.000.00
<br /> GENERAL AGGREGATE $2,000,000,00
<br /> _
<br />GEN'LAGGREGATE LIMITAPPUE3PER; PRODUCTS-COMP/OPAGG $2,000,000,00
<br /> Y POLICY PRO LOG
<br />E AUT DMO$ILELIA51LITY CA 3976576 (VA) 101112010 1011/2011 COMBINED SINGLE LIMIT $1,000,000.00
<br />E X CA39T0575 (ACS) 101112010 1011/2017 Eachaccldent
<br />E ANYAU70 CA 39765T7 (MA) 101112010 10/112011 BODILY INJURY (Per p.,--.n)
<br />F ALL OWNEDAUTO$ CA 39TG624(NH)(Primary AL) 101112010 1011/?a11% BQDILYINJURY (Per acciaenr
<br /> SCHEDULED AUTOS TO
<br />?? - PROPERTY DAMAGE
<br /> )? HIRED AUTOS v
<br />V .?+ (Per acGtlent)
<br /> NON-OWNED AUTOS -NEW HAMPSHIRE (CSL) $280,000
<br />
<br /> UMBRELLA LIAR OCCUR s L? y
<br />r'le EACH OCCURRENCE
<br /> X City At O
<br /> E
<br />994U LIAR CLAIMS-MADE ASC?j$ta It AGGREGATE
<br /> DEDUCTIBLE a
<br />I PRODUCTS- CAMP/OP AGG
<br /> RETENTION $ / NEW HAMPSHIRE (CSL)
<br />
<br />C WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY WC 0261495
<br />WC 020149514 (FL) 107112010
<br />10/112010 107172011
<br />10/112011 X TWO STATU- OTH-
<br />D YIN
<br />ED EGUTIVE ?
<br />ANY PRO RIE NIA WC 026149516 (MI) 10/1/2010 10/1/2011 6,L. EACH ACCIDENT $2,0[1,000.00
<br />E ER EXCLUD
<br />(Amdalory In NH) WO 026144513 (CA)
<br />WO 026149518 (MA
<br />ND
<br />NY
<br />OR 10/1/2010
<br />10/'1!2010 10/112011
<br />10/112011 E.L. DISEASE. EA EMPLOYE $2,000,000.00
<br />F Ity6s, ileac be under ,
<br />,
<br />,
<br /> DESCRIPTION OF OPERATIONS below WA WI WY E,L, DISEASE-POLICY LIMIT 52,000,000.00
<br />A Builder's Rlsk/Installatlon/Contract Works OC & OCW 91128600 511/2010 51112011 USD $1,000,000.00 per jobsilc
<br />A Rental EquipmenVConlractoes Equipmatl OC & OCW 91128600 511/2010 511/2011 U$D $1,000,000.00 pcrlobsita
<br /> T si K1112010, 511MIJ 1
<br />DESCRIPTION OF OPERATIONS I LOCATIONS /VEHICLES (Attach ACORa 161,Addrtional Remarks SchadUle, it more space is required)
<br />Project= SariLa Aria. Trhiri Station/SARTIC 4-5-10/SG#950323501
<br />Please refer to attached ACOAD 101 for further reinarks.
<br />...-,..,U I. - I= rl" r-rC
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />CITY OF SANTA ANA THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ATTN: PURCHASING DEPARTMENT ACCORDANCE WITH THE POLICY PROVISIONS.
<br />20 CIVIC CENTER PLAZA
<br />SANTA ANA, CALIFORNIA 92701-4010 AUTHQRI2EG REPRESENTATIVE
<br />United States 1 ?:? 1?- a,
<br />I n.aasKiUEA INQ S%..,.,.?m FranWir eHallmK Global WWo
<br />(0 1988-2009 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2009109) The ACORD name and logo are rogisterad marks of ACORD
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