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<br />SKEFENT-09 TSTORM
<br />p'��0i'Q CERTIFICATE OF LIABILITY INSURANCE
<br />oATEtMM10GDY Y1
<br />8/6/2096
<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 pollciss may require an endorsement. A statement on this certificate does not confer rights to the
<br />certificate holder in lieu of such endorsement a .
<br />PRODUCER License 4 OD20764
<br />NAEIacr Jennifer Hojnacki
<br />Orion Risk Manaf1ament Insurance Services, Inc.
<br />1800 Quail Street Suite 19tl
<br />Newport Beach, EA 92600
<br />P ONE Ax
<br />SID, (949) 263.8850_ AID Np 949) 263.8_860
<br />_
<br />ADDRIESS:
<br />INSURERS AFFORDING COVERAGE
<br />j NAICN
<br />�AGS0088300
<br />INEURERA:Ironshore Specialty Insurance Company
<br />25446
<br />EACH OCCURRENCE_
<br />INSURED
<br />INSURERS: Starr Indemnity &Liability Com any
<br />38318
<br />INSURER CI Great American Insurance Company
<br />16691
<br />Ban's Apshalt Inc.
<br />INSURER D:
<br />2200 S. Yale Street, Suite A
<br />Santa Ana, CA 92704.4404
<br />- —
<br />INSURER E; - —
<br />INSURER P:
<br />FER50NAL&ACV INJURY
<br />COVERAGES CERTIFICATE NUMBER: 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 SUBJBCT TO ALL THE TERMS,
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS,
<br />INSRrypE OF INSURANCE
<br />LTR
<br />II
<br />WVD
<br />POLICYNUMEER
<br />POLICY EFF
<br />i MMIcOIyyYy
<br />POLICY EXP
<br />MMIDDYYYY
<br />LIMITS
<br />A
<br />X
<br />COMMERCIALGENERALLIAEILITY
<br />CLAIMS -MADE X OCCUR
<br />X
<br />�AGS0088300
<br />0310112016
<br />tl3107 /2098
<br />EACH OCCURRENCE_
<br />$ 1,000,000
<br />PREMISES Eaaccunenca
<br />$ 60,000
<br />MEDEXP(my one person)
<br />I$ 6,000
<br />FER50NAL&ACV INJURY
<br />$
<br />AGGREGATE LIMIT APPLIES PER:
<br />GENERAL AGGREGATE
<br />___1,000,000
<br />$ 2,000,000
<br />GEHL
<br />POLICYn PEO LOC
<br />PRODUCTS-COMPIOPAGG
<br />2,000,000
<br />EaCccDeductlble
<br />_5
<br />$ 6,000
<br />OTHER,
<br />AUTOMOBILE
<br />LIABILITY
<br />COMacBINEOSINGLE LIMIT
<br />Do
<br />Ea
<br />$ 1,000,000
<br />BODILY INJURY (P., person)
<br />_
<br />$
<br />B
<br />X
<br />ANY AUTO
<br />SISIPCAD8287616
<br />03101/2016
<br />03101/2016
<br />ALL OWNED SCHEDULED
<br />AUTOS AUTOS
<br />HIREDAUTOSNON-OWNED
<br />AUTOS
<br />!
<br />BODILY INJURY(Fer accidsn0
<br />$
<br />PROPERTY DAMAGE
<br />Peraccident
<br />_
<br />$
<br />Comp/Coll Ded
<br />$ 2,00
<br />UMBRELLALIAB
<br />X
<br />OCCUR
<br />EACH OCCU_RREN_CE
<br />$ 5,000,000
<br />C
<br />X
<br />EXCESS LIAO
<br />CLAIMS-MAOE
<br />TUEDC1706006
<br />03IC112016
<br />031011`2016
<br />AGGREGATE
<br />$ 5,000,060
<br />BED I X RETENTION$ O
<br />$
<br />B
<br />WORKERS COMPENSATION
<br />ANOEMPLOYERS'LIABILITY
<br />ANY PROPRIETORIPARTNERIEXECUTIVE YIN
<br />OFFICERIMEMBEREXCLUDODP ®
<br />IMandatorylnNH)
<br />NIA
<br />1000001342
<br />03/01/2016
<br />0310112016
<br />X PER 0TH-
<br />STATUTE, ER
<br />$ 1,000,000
<br />E.L EACH ACCIDENT
<br />" '-
<br />E, L. DISEASE, EA EMPLOYEE
<br />$ 1,000,000
<br />OESbRIPTION OF OPERATIONS below
<br />E, L. DISEASE -POLICY LIMIT
<br />$ 1,000,000
<br />DESCRIPTION Of OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Addltleaal Romarhu Schedule, maybe altsched if mora space is required)
<br />Re: Job MOOGL Project No.13.2638; Portola Park Improvements
<br />The City of Santa Ana, 20 Civic Center Plaza, Santa Ana, California 92701; Its officers, employees, agents and representatives are named Additional Insured &
<br />Primary & Non -Contributory Wording per CO20f 0 07041002037 0704. 30 day notice of cancellation; 10 day for non-payment of premium.
<br />CERTIFICATE HOLDER CANCELLATION
<br />©1988.2014 ACORD CORPORATION. All rights reserved.
<br />ACORD 26 (2014/01) The ACORD name and logo are registered marks of ACORD
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORK
<br />City
<br />Cit of Santa Ana
<br />Attn: Purchasing Department
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS,
<br />20 Civic Center Plaza
<br />AUTREPRESENTATIVE
<br />Santa Ana, CA 92701
<br />"HORIZED
<br />-
<br />1
<br />©1988.2014 ACORD CORPORATION. All rights reserved.
<br />ACORD 26 (2014/01) The ACORD name and logo are registered marks of ACORD
<br />
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