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CERTIFICATE OF LIABILITY INSURANCE
<br />1 DATE(M OBI0412014 Y)
<br />I2014
<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 policy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to
<br />the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the
<br />certificate holder In lieu of such endorsement(s).
<br />PRODUCER
<br />ADD Risk Insurance services west, Inc.
<br />Los Angeles CA Office
<br />CONTACT
<br />NAME:
<br />(,CNNO.Exp: (866) 283 -7122 FAX (800) 363 -0105
<br />EMAIL
<br />ADDRESS:
<br />707 Wilshire Boulevard
<br />Suite 2600
<br />INSURER(S) AFFORDING COVERAGE
<br />NAICM
<br />Los Angeles CA 90017 -0460 USA
<br />INSURED
<br />INSURERA: National Union Fire Ins cc of Pittsburgh
<br />19445
<br />rat rd tech, IDC. (IWR)
<br />17885 von Kerman Ave.
<br />Ste. 500
<br />INSURERS: The Insurance Co of the state of PA
<br />19429
<br />INSURER m Lexington insurance Company
<br />19437
<br />Irvine CA 92614 USA
<br />INSURER D: AIG Europe Limited
<br />AA1120841
<br />INSURER E:
<br />PREMISES Ea occurrence
<br />INSURER F:
<br />X
<br />MED EXP(Any one person)
<br />COVERAGES CERTIFICATE NUMBER: 570054003817 REVISION NUMBER:
<br />THIS IS 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 OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. Limits shown are as requests
<br />I�TR
<br />TYPE OF INSURANCE
<br />INSD
<br />WD
<br />POLICY NUMBER
<br />City of Santa Ana
<br />AUTHORVED REPI ENTATNE
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL-GENERAL-LIABILITY
<br />Brian ige
<br />220 5. Daisy Ave.
<br />�y��61� y��
<br />(
<br />GL
<br />"ieffD99ffiMMMIDDAIYYYI
<br />L.1rYan ✓✓
<br />EACH OCCURRENCE
<br />$1,000,000
<br />CLAIMS -MADE �% OCCUR
<br />PREMISES Ea occurrence
<br />$1,000,000
<br />X
<br />MED EXP(Any one person)
<br />$10,000
<br />X,O,U coverage
<br />PERSONAL B ADV INJURY
<br />$1,000,000
<br />GEWL AGGREGATE LIMIT APPLIES PER:
<br />GENERAL AGGREGATE
<br />$2,000,000
<br />POLICY ❑X ECT PRO �X LOC
<br />PRODUCTS - COMPIOP AGG
<br />$2,000,000
<br />OTHER:
<br />A
<br />AUTOMOBILE LIABILITY
<br />CA 327 52 65
<br />10/01/201310/01
<br />/2014
<br />COMBINED SINGLE LIMIT
<br />Ea accident
<br />$1,000,000
<br />BODILY INJURY (Per Famear)
<br />X ANY AUTO
<br />BODILY INJURY (Per accident)
<br />ALLOWNED SCHEDULED
<br />AUTOS AUTOS
<br />NON OWNED
<br />PROPERTY DAMAGE
<br />X HIRED AUTOS X
<br />AUTOS
<br />Peracciden[
<br />X ISO Policy Farm CA
<br />D
<br />%
<br />UMBRELLALIAB
<br />X
<br />OCCUR
<br />TH1300027
<br />10/01/2013
<br />10/01/2014
<br />EACH OCCURRENCE
<br />$1,000,000
<br />EXCESS LIAR
<br />CLAIMS -MADE
<br />AGGREGATE
<br />$1,000,000
<br />DED X
<br />RETENTION 8100,000
<br />B
<br />WORKERS COMPENSATION AND
<br />WC15 5 017
<br />15715172513
<br />10 O1 2014
<br />A. PER OTH-
<br />STATUTE ER
<br />B
<br />EMPLOYERS' LIABILITY YIN
<br />WC15656011
<br />10/01/2013
<br />10/01/2014
<br />E.L. EACH ACCIDENT
<br />$1,000,000
<br />B
<br />ANY
<br />NIA
<br />WC15656012
<br />10/01/2013
<br />10/01/2014
<br />OFFICEWMEM ERIEXCLUDED?EXECUTIVE
<br />(Mandatory In NH)
<br />E.L. DISEASE -EA EMPLOYEE
<br />$1,000,000
<br />DE SCRIPTIION OF OrPERATIONS below
<br />E.L, DISEASE - POLICY LIMIT
<br />$1,000,000
<br />C
<br />contractor Prof
<br />028182375
<br />10/01/2013
<br />10/01/2014
<br />Each Claim
<br />$1,000,000
<br />Prof /Poll Liab
<br />Agggregate
<br />$1,000,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached it more space Is required)
<br />RE: on -call water Resource Engineering Services. city of Santa Ana, its officers, employees, agents, volunteers and
<br />representatives are included as Additional Insured in accordance with the policy proviso s Of the General Liability policy.
<br />General Liability policy evidenced herein is Primary and Non - contributory to other insur n e ava to certificate Holder,
<br />but only in accordance with the policy's provisions. A waiver of Subrogation is gr Led i #�fBs rtificate Holder in
<br />accordance with the policy provisions of the General Liability, Automobile Liabi r lq4 iability and Workers'
<br />Compensation policies. Stop cap coverage for the following states: ONA,P E)
<br />CERTIFICATE HOLDER CANCELLAT „a Sari�$'�' etnTTle�i
<br />©1988.2014 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD
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<br />SHOULD AN THE 11 OLICIES BE
<br />CANCELLED BEFORE THE
<br />EXPIRATION PI T '11 FNEIiE{gj, E WILL BE DELNERED
<br />IN ACCORDANCE WITH THE
<br />POLICY PR0�1" 6.
<br />City of Santa Ana
<br />AUTHORVED REPI ENTATNE
<br />Public works Agency
<br />Brian ige
<br />220 5. Daisy Ave.
<br />�y��61� y��
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<br />Santa Ana CA 92702 USA
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<br />©1988.2014 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD
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