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<br />°0 CERTIFICATE OF LIABILITY INSURANCE
<br />l DATE
<br />(
<br />Y)
<br />ki? 6/14/
<br />2013
<br />LY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
<br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
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<br />ER THE COVERAGE
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<br />CERT F CATE
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<br />HIS
<br />INS AUTHORIZED
<br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
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<br />RE,D, t po c I, s) must be endorsed. If SUBROGATION IS WAIVED, subject to
<br />IMPORTANT:. If the certificate holder Is an A0
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<br />the terms and conditions of the policy, certain h lei m'd i (Wei d nt. A statement on this certificate does not confer rights to the
<br />certificate holder In Ileu of such endorsement(s). ` FPtR
<br />PRODUCER NAME: Brian ODrand
<br />Construction Risk Solutions, LLC. PHONE - PAX
<br />11311 McCor
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<br />k Road
<br />Ste 450
<br />- -
<br />ac No Ex : - - A/c No: 443
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<br />Hunt Valley MD 21031-8622 noDRess: certificatesOthecrsteam.com
<br /> PRODUCER
<br /> CUSTOMER ID p:
<br />
<br /> INSURERS) AFFORDING COVERAGE NAIC4
<br />INSURED INSURERA:Ne Hampshire Insurance Cc 23841
<br />Structural Group, Inc.
<br />i INSURER e: National Union Fire Ins Cc Pittsbur 19445
<br />dge Road
<br />7455-T New R
<br />Baltimore, MD 21076 INSURERC:Catlin Specialty Insurance Company 19518
<br />
<br /> INSURERD.:XL Specialty Insurance Com an 37885
<br />! INSURERS:
<br />2 3
<br />/
<br /> INSURER F:
<br />COVERAGES CERTIFICATE NUMBER: 1032604928 REVISION NUMBER:
<br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE SEEN ISSUED TO. THE INSURED NAMED ABOVE FOR THE POLICY
<br />PERIOD INDICATED.. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO
<br />WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT
<br />TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />ILSR TYPEOFINSURANCE INSODL R SUB POLICY NUMBER MWDIDY/YEY Y MMIODmYY LIMITS
<br />a GENERAL LIABILITY 2449508 7/1/2013 7/1/2014 EACH OCCURRENCE $2,000,000
<br /> X COMMERCIAL GENERAL LIABILITY
<br />PREMISES (E. ocunence
<br />$1,000,000
<br /> CLAIMS-MADE X? OCCUR MEDEXP An one erson $5,000
<br /> PERSONAL &AOV INJURY $2,000,000
<br /> GENERALAGGREGATE $4,000,000
<br /> GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $4,000,000
<br /> POLICY % PRO- X LOC
<br />1PcT $
<br />H AUT OMOBILE LIABILITY 3506359 7/1/2013 7/1/2014 COMBINED SINGLE LIMIT $2,000,000
<br /> (Eaaccident)
<br /> X ANY AUTO BODILY INJURY (Per person) $
<br /> ALL OWNED AUTOS BODILY INJURY (Per accident) $
<br /> SCHEDULED AUTOS PROPERTY DAMAGE
<br /> X HIRED AUTOS (Peraccldenl) $
<br /> X NON-OWNED AUTOS $
<br />
<br />D X UMBRELLA LIAB X OCCUR US00062096LI13A 7/1/2013 7/1/2014 EACH OCCURRENCE $10,000,000
<br /> EXCESS LIAB CLAIMS MADE AGGREGATE $1010001000
<br /> DEDUCTIBLE $
<br />
<br />X
<br />RETENTION $10,000 _
<br />$
<br />A WO
<br />N RKERS COMPENSATION
<br />D EMPLOYERS' LIABILITY 015883713 7/1/2013 7/1/2014 OEH-
<br />X M '
<br /> A
<br /> ECUTIVE ?
<br />ANYPROPRIET RIPAR E.L. EACH ACCIDENT
<br />NT $1,000,000
<br /> .UDE07
<br />(Mandatory In NH) NIA E.L.DISFASE-EAEMPLOYE $1,000,000
<br /> D
<br />O
<br /> E 3CRIPTI
<br />N OF OPERATIONS below E.L. DISEASE-POLICY LIMIT $1,000,000
<br />C ProEeaaional Liability
<br />CPL95994-0714
<br />7/1/2013
<br />7/112014
<br />Per Occurrence $5,000,000
<br /> I Per Aggregate $5,000,000
<br />DESCRIPTION OF.OPERATIONS /LOCATIONS/VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required)
<br />Re: Job No. 109646 - City of Santa Ana - Fiesta Market Place Parking Structure PT Repair City of Santa
<br />Ana, its officers, employees, agents, volunteers and representatives are included as additional insured
<br />with respect to all policies except workers' compensation. Insurance provided is primary and
<br />non-contributory. The general liability policy includes separation of insureds.
<br />CERTIFICATE HOLDER CANCELLATION30 davs/10 davs for non-payment
<br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED
<br /> BEFORE THE EXPIRATION DATE THEREOF NOTICE WILL BE DELIVERED
<br />IN ACCORDANCE WITH THE POLICY PROVISIONS.
<br />City of Santa Ana
<br />20 Civic Cengefy f z?/
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<br />Santa Aria CA 0 `1956` AUTHORIZED REPRESENTATIVE
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<br />Lau',, ' r, ti - ©1988.2009 ACORD CORPORATION. All rights reserved.
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<br />ACORD 25 (2009/09) A,SS15tdhs ACQ,Mgfffloar(d logo are registered marks of ACORD
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