|
�,r-�alr1 WKEINCO-01 GOMEZB
<br />CERTIFICATE OF LIABILITY INSURANCE DATE�(MMIOR'YYYY]
<br />14....--'"` 1112212013
<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 />CONTACT
<br />PRODUCER License #CE6776B NAME: All Smith
<br />IDA Insurance Services -SD PHONE ( (uc Nel, (S19) 574-6288
<br />4350 La Jolla Village Drive, Suite 900 AIc No er _ 619) 574.6220
<br />I INSLARER15T AFFORDING COVERAGE NAIL# I
<br />WKE, Inc.
<br />400 N. Tustin Ave., 0285
<br />Tustin, CA 92705
<br />COVERAGES_ CERTIFICATE NUMBER: REVISION NUMBER:
<br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO TH E INSURED NAMED ABOVE FOR TH E POLICY PERIOD
<br />INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTH ER 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 ALLTHE TERMS,
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />ILIR TYPE OF INSURANCE INSft YWD POLICY NUMBER IMM(DDAYYYY „(MMIDOfYYYY) LIMITS
<br />GENERAL LIABILITY EACH OCCURRENCE $^ 2,000,0
<br />A X COMMOIECtAL GENERAL UABILITY X X PSB0001793 10!9112013 1011112014 DAMACA FO PREMISES BIEN� rrencat $ 1,000,0
<br />CLAiMS-6AADE ® OC,'.U1R MED EXIT (Arty once person) $ 10,0
<br />X Contractual Liab. PERSONAL S ADD INJURY $ 2,000,0
<br />X No Co. Owned Autos GENERAL AGGREGATE $ 4,000,0
<br />GEHL AGGPEGATF LIMIT APPLIES PER PRODUCTS-COMP/OP AGO $ 4,000,0
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required)
<br />Re: Fifth Street Bridge at Santa Ana River
<br />City of Santa Ana, its officers, employees, agents, volunteers and representatives are Additional Insurod with respect to General/Hired & Non -Owned Auto
<br />Liability par the attached endorsement as required by written contract. Insurance is Primary and Non -Contributory. Wavier of Subrogation applies to General
<br />Liability and Workers Compensation.
<br />Days Notice of Cancellation with 10 Days Notice for Non -Payment of Premium in accordance with the policy provisions.
<br />4
<br />U SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />>P .__.,._._ THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />�`
<br />Laura Sri ShI edy ACCORDANCE WITH THE POLICY PROVISIONS.
<br />City of Santa Ana Assistant City Fsttorney
<br />ATTN: Mindy Ly AUTHORIZED REPRESENTATIVE
<br />20 Civic Center Plaza
<br />Ross Annex (M36)
<br />IS_,anta Ana CA 92709
<br />O 1988-2010 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD
<br />LIABILITY
<br />"dpn[F"""""'Z'UUU,
<br />EaaccidenH
<br />�_,,,-
<br />UUU
<br />AANY
<br />AUTO X
<br />PSB0001793
<br />10/11/2013
<br />10/1112014
<br />BODILY INJURY(Perperson)
<br />$
<br />ALL OYNED SCHEDULED
<br />BODILY IN,;URY(PorecclderINAUTOS
<br />HAUTOMOSILE,
<br />AUTOSRNON-OVMIED
<br />y`
<br />PPERACCIDRNTAGEHIRED
<br />AU70G AUTOS
<br />P
<br />RELLA LIAR X OCCUR
<br />EACH OCCURRENCE
<br />$
<br />2,000,000
<br />A
<br />EXCESS LIAB CLAIMS-rTADE
<br />IDEC011:1
<br />SE0001694
<br />1421112013
<br />1011912014
<br />AGGREGATE
<br />$
<br />2,000,00
<br />RETENTI`)N $
<br />.$
<br />WORKERS COMPENSATION
<br />ILIO STATU- OTFI-
<br />ANDEMPLOYERS'UABILnY
<br />TORY LIINITS ER
<br />A
<br />ANY PROFRIFTORIPARTNERIE(ECUT VEY�NIA
<br />X
<br />PSW00011314
<br />10111/2013
<br />90/1112014
<br />Et. EACH ACCIDENT
<br />$
<br />1,000,000
<br />OFFIGERMIEMBER EXCLUDED?
<br />1,000,000
<br />(Mandatory In NH)
<br />E.L. DISEASE - EA EMPLOYEE
<br />$
<br />fm describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE -POLICY LIMIT
<br />$
<br />1,000,000
<br />B
<br />Prof Llab/Clens Made
<br />DPL274413
<br />10/1112013
<br />10/11/2014
<br />Per Claim
<br />2,000,000
<br />B
<br />Ded.:$15k Chns Made
<br />DPL274413
<br />10/11/2013
<br />10/91/2014
<br />Aggregate
<br />2,000,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required)
<br />Re: Fifth Street Bridge at Santa Ana River
<br />City of Santa Ana, its officers, employees, agents, volunteers and representatives are Additional Insurod with respect to General/Hired & Non -Owned Auto
<br />Liability par the attached endorsement as required by written contract. Insurance is Primary and Non -Contributory. Wavier of Subrogation applies to General
<br />Liability and Workers Compensation.
<br />Days Notice of Cancellation with 10 Days Notice for Non -Payment of Premium in accordance with the policy provisions.
<br />4
<br />U SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />>P .__.,._._ THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />�`
<br />Laura Sri ShI edy ACCORDANCE WITH THE POLICY PROVISIONS.
<br />City of Santa Ana Assistant City Fsttorney
<br />ATTN: Mindy Ly AUTHORIZED REPRESENTATIVE
<br />20 Civic Center Plaza
<br />Ross Annex (M36)
<br />IS_,anta Ana CA 92709
<br />O 1988-2010 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD
<br />
|