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PAULUS ENG EVELASCO
<br />CERTIFICATE 4F LIABILITY INSURANCE
<br />DAT4r27�212712 a1 (MMfDYY6
<br />s
<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(ies) must be endorsed. If SU'BROGATI'ON IS WAIVED, subject to
<br />the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate dries not confer rights to the
<br />certificate holder in lieu of such endorsement(s).
<br />PRODUCER
<br />CONTACT
<br />NAME:
<br />The Wooditch Company Insurance Services, Inc.
<br />1 Park Plaza, Suite 400
<br />Irvine, CA 92614
<br />_.._ ........_.—.._......— T�
<br />PHONE (949) 553-9500 I Cw Nmg: C 49) 553 ti67ii
<br />E-MAIL
<br />ADDRESS; .
<br />...
<br />INSURERt5) AFFORDING COVERAGE
<br />NAJC q
<br />PaMMSEPNED 100,000
<br />INSURER A: Executive Risk Indemnity„ Inca
<br />35181
<br />INSURED
<br />INSURER B: Federal Insurance Company
<br />20281 �—.._..
<br />INSURER c m
<br />Paulus Engineering, Inc.
<br />INSURER D
<br />2871 E. Coronado Street
<br />Anaheim, CA 92806
<br />INSURER E ;
<br />INSURER F:.
<br />COVERAGES CERTIFICATE NUMBER: R17W.SIFIN hIIlMRFR—
<br />THIS IS TO CERTIFY THAI' 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 TMS
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS S'UBJ'ECT TO ALL THE TERMS,
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />N—Si _m_m_.,_. _..,._..w... _—A U99
<br />LTR TYPE OF INSURANCEIt3s01 W4'D POLICY NUMBER MOL IC7YY EFF MM ICY YJY_EXP LlMirs
<br />A
<br />X
<br />� COMMERCIAL GENERAL LIABI'LrrY
<br />CLAIMS -MADE FRI OCCUR
<br />X
<br />54303105
<br />05101/2016
<br />05/01/2017
<br />EACH OCCURRENCE _$—tl�— 1 ,000,000
<br />PaMMSEPNED 100,000
<br />MED EXP {Anyone person) $ 5,000
<br />PERSONALaADvirsluRv $ 1,000,000
<br />GEN"L AGGREGATE LIMIT APPLIES PER:
<br />POLICY ECT �LQG
<br />GENERAL AGGREGATE $ 2,000,000
<br />PRODUCTS-OaM9PlOP AGG $ 2,000,000
<br />p, $
<br />OTHER:
<br />tl
<br />gg
<br />i
<br />AUTOMOBILE
<br />X
<br />LIABILITY
<br />ANY AUTO
<br />ALL OWNED SCHEDULED
<br />AUTOS AUTOS
<br />5
<br />I�
<br />154303104
<br />0510112016
<br />'�
<br />05101/2017
<br />COMBINED SINGLE LIMIT
<br />Ea accidentl t $ 1,000,000
<br />BODILY INJURY (Per persu") s
<br />BODILY INJURY (Per accident) ; $
<br />NaNdiWNED
<br />HIRED AUTOS AUTOS
<br />PROPERTY DAMAGE
<br />(Per accidentt ` $
<br />a
<br />UMBRELLA LtAB OCCUR.
<br />i.
<br />EACH OCCURRENCE S
<br />AGGREGATE. $ ...�..
<br />EXCESS LIARCLAIMS-MADE
<br />-.
<br />DED RETENTIDMS
<br />! $
<br />B
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS" LIAR I r Y Y L N
<br />ANY PROPRIET)RAPARTNER)FXFOJTIVE c�
<br />OFFICERIMEM9ER EXCLUDED? LJ
<br />(Mandatary' in NH)
<br />If ns, describe. under
<br />'.., DESCRIPTIOiN FOPERATIONS below
<br />NIA
<br />!
<br />54303106
<br />0510112016
<br />0510112017
<br />PER g OTH-
<br />" STATUTE Y ER
<br />E.L.EACHACCIDENT $ 11000,000
<br />_._....—
<br />._.._..
<br />r. L'. DISEASE - EA.EMPLOYE$ '1,0011,000
<br />E. L. DISEASE, -POLICY LIMIT �'. S 1,000,000
<br />DESCRIPTION OF OPERATIONS f LOCATIONS f VEHICLES (ACORD 101, A.ddltlonal Remarks Schedule, may be attached 4 more spare Is required)
<br />RE: Sana Ana Emergency Work. RE: Santa Ana Emergency Work. glatp
<br />City of Santa Ana, its officers, employees, agents, volunteers and representatives are Named as Additional Insureds as respects General Liability per
<br />Attached Endorsement.
<br />This Insurance shall apply as Primary and Non -Contributory per attached endorsement.
<br />CERTIFICATE HOLDER CANCELLATION
<br />City of Santa Ana
<br />220 S. Daisy Ave., M-85
<br />Santa Ana, CA 92702
<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;
<br />G� ✓
<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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