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, ccs► ca► CERTIFICATE OF LIABILITY INSURANCE
<br />DATE(MM/DDrYYYY)
<br />'
<br />911/2015
<br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE H'=OLDER. 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 Patriot Disk & Insurance Services
<br />����ACT
<br />100 Spectrum Center Drive, Suite #400
<br />Irvine CA 92618
<br />15iI(7NE 949
<br />Alc,hla_Ex11, 4x49 as) 6- 900 A/C Nal: 4 1486-7950
<br />E-MAIL
<br />ADDRESS:
<br />91112016
<br />EACH OCCURRENCE $ 1,000,000
<br />PPREMISEs Ea_o_g94 ence $ 300,000........
<br />iNSURFR(Sl AFFORDING COVERAGE NAIC
<br />wuaw.patrisk.cDm OG55454 _
<br />RSURERA: Valle Forge lnsura! Company_..._
<br />20500
<br />INSURED
<br />T. ts, IAv
<br />INSURER B; Continental Casualty Company
<br />x...
<br />20443
<br />INSURER C : Torus National Insurance Company
<br />.._.
<br />25496
<br />3.
<br />306 W..Kat Katella Avenue,. Unit 'B'
<br />_
<br />INSURER D:
<br />Orange CA 92867
<br />INSURER E.
<br />INSURER F:
<br />AGGREGATE LIMIT APPLIES PER:
<br />✓
<br />POLICY ECT E LOC
<br />=MWra.acrexer n"eArar INEIW
<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.
<br />INTR
<br />LTR
<br />ITYPE OF INSURANCE
<br />�,ADDL
<br />JUMV
<br />SUBR
<br />D
<br />POLICY NUMBER
<br />POLICY EFF....
<br />MMiDDIYYYY
<br />POLICY EXP
<br />MMIDD/YYYY
<br />_
<br />OMITS
<br />A
<br />/
<br />COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE OCCUR
<br />6014373100
<br />91112015
<br />91112016
<br />EACH OCCURRENCE $ 1,000,000
<br />PPREMISEs Ea_o_g94 ence $ 300,000........
<br />V
<br />MED EXP (Anyone person)$ 5„000
<br />$SOCIO Deductible
<br />PERSONAL&ADV 'INJURY .. $.... 1,000,000
<br />AGGREGATE LIMIT APPLIES PER:
<br />✓
<br />POLICY ECT E LOC
<br />GENERAL AGGREGATE �. �.._ 2,000,000
<br />._.-_ m_._.. ...._
<br />PRODUCTS -COMP!(7PAC.roLx' $ 2,000,000'
<br />.._
<br />GEN'L
<br />$
<br />OTHER:
<br />B
<br />AUTO
<br />MOBILELIABILITY
<br />6014373114
<br />911/2015
<br />911/2016
<br />COMBINEDSINGLELIMIT $
<br />Ea accident. 1,000 000
<br />BODILY INJURY (Per person,) $
<br />f
<br />ANY AUTO
<br />ALL OWNED SCHAUTOS
<br />AUTOS AUTOS
<br />BODILY INJURY Per accident) S
<br />(NON
<br />-OWNED
<br />HIRED AUTOS AUTOS
<br />k
<br />PROPERTYDAI+AAGE
<br />Peraer�deatY $
<br />$
<br />A
<br />✓_
<br />UMBRELLA LIAB ,�^_
<br />OCCUR
<br />6014373128
<br />9/1/2015
<br />91112016
<br />EACH OCCURRENCE $ 6,000,000
<br />EXCESS LIAR
<br />CLAIMS -MADE
<br />.�� _m. ._..
<br />AGGREGATE $ 6,000,000'..
<br />DED RETENTION $
<br />$
<br />C
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY YIN
<br />ANY PROPRIETORIPARTNERIEXECUTIVE
<br />OFFICERIM EMBER EXCLUDED?
<br />N P A.
<br />710140069
<br />9/112015
<br />911/2016
<br />77 7P—ER�TH-
<br />✓ STATUTE ER.
<br />E.L. EACH ACCIDENT $ 1,000,000
<br />E.L. DISEASE- EA EMPLOYE s 1,000,000
<br />___..,._. .__.
<br />(Mandatary In and
<br />Iff yes, describe under
<br />�
<br />'_,.-.
<br />DESCRIPTION OF OPERATOONS below
<br />E L DISEASE - POLICY LIMBI $ 1,000,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHMCLES (ACORD 101, Additional Remarks Schedule, may be attached it more space is regoared)
<br />Re:Agreement for On‐Call Sewer and Water System Repair Services throughout the City of Santa Ana, CA
<br />City of Santa Ana, its officers, employees, agents, volunteers and representatives are named as Additional Insureds, includes Primary and
<br />Non-contributory as respects to General Liability per endorsements attached where required by written contract.
<br />30 days notice of cancellation, 10 days for non-payment Of premium.
<br />C2y of Santa Ana
<br />Public Works Agency - Water Resources
<br />20 Civic Center Plaza (M-30)
<br />Santa Ana CA 92701
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION' DATE THEREOF, NOTICE WILL. BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />AUTHORIZED REPRESENTATIVE x
<br />Leonard E.2iminsky
<br />(9 1888-2014 ACORD CORPORATION. All rights reserved,
<br />ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD
<br />a
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<br />Thir ce: �rtificate cancels aced .s, persedes ALL prev:iouslN issued certificat+as.
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