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<br />CNSURANCE I DATE MIDDY'
<br />101312010
<br />CERTIFICATE OF LIABILITY CNSURANCE DAT
<br />DD/
<br />(NT
<br /> 01
<br />0
<br />313112 01
<br />10
<br />0
<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 be endorsed- If SUBROGATION IS WAIVED, subject to
<br />the terms and conditions of the policy, certain policies may require an endoream&nt- A statement on this certificate does not confer rights to the
<br />certificate holder in lieu of such endorsements .
<br />PRODUCER
<br />NAME.
<br />Marsh
<br />Ina FAX
<br />, A/C No NC No:
<br />Fat: 345-5000
<br />1166 Avenue of the Americas A
<br />New York
<br />NY 10036 ADDRESS:
<br />, PRODUCER
<br /> CUSTOMeRID
<br /> INSURERS AFFORDING COVERAGE NAIC0
<br />INSURED INSURER A: ACIDS 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 92868 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 NIIMRFR-
<br />THIS 15 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 Or SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />INSR DDL SUBR POLICYEFF POUCYEFP
<br />LTR TYPEOFINSURANCE POUCY NUMBER MM/DD/YWY MMIDDNYY LIMITS
<br />F GENERALUABILRY GL 4300884 (Primary GL) 101112010 10/1/2011
<br />EACH OCGVRRENCE
<br />SL000,000.00
<br /> X COMMERCIAL GENERAL LIABILITY PREMISES Eaommm?x 51,000.000.00
<br />
<br /> GUIM$•MADE 7 OCCUR MEDEXP Anyona Demon 510,00.00
<br /> OWNER'68 CONTRACTOR'S PERSONAL &AW IWURY 31.000,000.00
<br /> GENERAL AGGREGATE 52,00000.00
<br /> GEW4 AGGREGATE UMRAPPUEO PER, PRODUCTS-COMP/OPAGG 52,0001000,00
<br /> x PDUCY MT LOC
<br />E AUT OM091LE LIABILITY CA 3976576 (VA) 10112010 10/112011 COMBINED SINGLE LIMIT 51,000,000,00
<br />E )( CA3576575 (ADS) 10112010 10/12011 ERChecdden
<br />E ANyALIro CA 39765T7 (MA) 10112010 10/12011 BODILY INJURY (Per perm)
<br />F ALLOWNEDAUTOS CA 3976624 (NH) (Primary AL) 10!120 PerecdCeno
<br />NVILY INJURY
<br /> 6CHEDULEDAUTOE ?tp??YY
<br />E PROPERTY OAJUAGE
<br />AM
<br /> HlREO AUTOS O V r (Peracdtl nr)
<br /> PS
<br />EW
<br /> NON•OWMED AUTOS HAM
<br />HIRE(CSL)
<br />- N $250,000
<br /> h
<br /> UMBRELLA LIAO OCCUR LI t Orr)eJ EACH OCCURRENCE
<br /> EXCE6a LIAR CLAIMS-MADE Assists A
<br />It City AGGREGATE
<br /> DEDUCTIBLE PRODUCTS - COMP/OP AGO
<br /> RETENTION S
<br />NEW HAMPSHIRE (CSL)
<br />B WORKERS COMPENSATION
<br />AND EMPLOYFRS•LIA6IUTY WC 02614
<br />WC 026149514 (FL) 10/1/2010
<br />10112010 101112011
<br />10M/2011 X 10SMS OR
<br />C YIN
<br />ECU)VE
<br />ANY PROP IE
<br />EEOx NIA WC026149516 (SMI 10/12010 1011/2011 E.L. EACH ACCIDENT
<br />$2,000.0O0.OB
<br />E 0
<br />EREXCm
<br />(Mand.,.U In NH) WC 0261495131DA)
<br />WC 026149516
<br />MA
<br />ND
<br />NY
<br />OH 1011/2A10
<br />10
<br />12010 10/1/2011
<br />10/12011 E.L. DISEASE.EAEMPLOYE $2,000,000.00
<br />F Ryes, tlesedbe under (
<br />,
<br />,
<br />,
<br />, 1
<br /> DESCRIPTION OF OPERATIONSbel. WA WI WY E,L, DISEASE-POLICY LIMIT SZ,000,000.00
<br />A Builders RlsVinstallatlon/Contract Works OC & DOW 91128600 6/12010 5112011 USO $1,000,000,00 per jobsit0
<br />A Rental Equipment/Contradoec Equipmont OC & COW 911286DO 5112010 511/2011 USD $1,000,000.00 pcrjobsita
<br /> T
<br />0E60RIPTIONOFOPER MONSILOCAnONS/VEHICLES (Ameb ALOR01d1•Addtronal RrmaT Ochodule,lfmweepacebTepuimd)
<br />ProleCtr Santa Ana Traia Station/SARTIC 4-5-10/90#050323501
<br />Please refer to attached ACORD 101 for further rsmrk3.
<br />CITY OF SANTA ANA
<br />ATTN: PURCHASING DEPARTMENT
<br />20 CIVIC CENTER PLAZA
<br />SANTA ANA, CALIFORNIA 92701-4010
<br />United Slates
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES DE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS-
<br />AUTHORIZED REPRESENTATIVE
<br />Brandin Helleek eloMl MndnB
<br />All riaht-a reserved.
<br />ACORD 25 (2009109) The ACORD name and logo are registered marks of ACORD
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