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MARK THOMAS AND COMPANY A-2015-173 REVIEWED BY:
<br />EUNICE HEREDIA (PG I OF 8)
<br />ACORD CERTIFICATE OF LIABILITY INSURANC9/16/2E ATE (MDONY)
<br />015
<br />THIS CER I'iFICATE IS IS960 4§'A MATTER OF INFORMATION ONLY AND CONFERS NO *FftsbPbN THE CERTIFICATE HOLDER TRIPS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY
<br />AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),
<br />AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER
<br />IMPORTANT; If the certificate ho1dor is an ADDITIONAL INSURED, the policy(ios) must be andorsed. it SUBROGATION IS WAIVED, subject to the terms and conditions of the poficyo certain policies may require an
<br />endorsement. A statement on this cerfiflatato done not confer r1ahts to the certificate holder In Heu of such endorsements .
<br />Producer License Nuinber: OA91339
<br />CONTACT NAME:
<br />PHONE
<br />(A/C, No, Exo: 866-966-8928 (A/CFA� )408-271-1802
<br />, No:
<br />Ascro Insurance Services
<br />200 N. Almaden Blvd., 3 it Floor
<br />E-MAIL
<br />ADDRESS: Cert$@aseroins.com
<br />San Jose, CA 95110
<br />INSURER(S) AFFORDING COVERAGE
<br />NAIC#
<br />INSURED
<br />INSURER A: Travelers Ind. Co. of CT
<br />Mark Thomas & Company, Inc,
<br />L_INSURERS: Depositors Insurance Co.
<br />1960 Zrinker Road
<br />INSURER C. Travelers Prop, Cos. Co. of America
<br />San Jose, CA 95112
<br />INSURER D:
<br />INSURER E:
<br />INSURER R=
<br />COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
<br />THIS
<br />8 IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY
<br />REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE
<br />POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONUTTIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS,
<br />INSR
<br />LTR
<br />TYPE OF INSURANCE
<br />ADDL
<br />INSD
<br />SUBR
<br />WVD POLICY NUMBER
<br />POUCYEFF
<br />MM/DDNYYY
<br />POLICY EXP
<br />(MM;DD/YYYY)
<br />LIMITS
<br />0 COMMERCIAL GENERAL LIABILITY
<br />[I [J MIMS-MADE 0 OCCUR
<br />EACH OCCURRENCE--
<br />EACH
<br />$ 1,000,000
<br />TO RENTED
<br />PREMISES (Ea occurrence
<br />$ 1,000.,()00
<br />A
<br />0
<br />6809ED9M7
<br />09/15/15
<br />09115/16
<br />MED EXP (Any one person)
<br />$ 10,000
<br />0
<br />PERSONAL& AUV INJURY
<br />$ 1001000 1
<br />GENERAL AGGREGATE
<br />$ 2,000,000
<br />PRODUCTS-COMPIOP AGG
<br />2,000,000
<br />GENT AGGREGATE LIMIT APPLIES PER
<br />0 POLICY 0 PROJECT ED LOC
<br />OOTHER
<br />I
<br />$
<br />AUTOMOBILE LIABILITY
<br />0 ANY AU rO
<br />COMBINED SINGLE LIMIT
<br />(Ea accldent)
<br />$ 1,000,000
<br />II
<br />[I ALL OWNED AUTOS
<br />[I SCHEDULED AUTOS
<br />ACP3006833955
<br />09115115
<br />09/15/16
<br />BODILY INJURY (Per PeNwi)
<br />$
<br />BODILY INJURY (Per Accident)
<br />$
<br />0 HIRED AUTOS
<br />0 NON -OWNED AUTOS
<br />PROPERTY DAMAGE
<br />(Per accident)
<br />0 $500 COMP. DEG.
<br />EI$1,000 COLL. DED.
<br />0 UMBRELLA LIAR' 0 OCCUR
<br />0 EXCESS LIAR [I CLAIMS -MADE
<br />EACH OCCURRENCE
<br />$ 4,000,000
<br />AGGREGATE
<br />$ 000,000
<br />CUP009E095562
<br />09115/15
<br />09/15/16
<br />[I DEDUCTIBLE
<br />El RETENTION $
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY
<br />UB4342'r25O15
<br />09115/15
<br />09/15/16
<br />W PER STATUTE OTH
<br />ER
<br />C
<br />I
<br />ANY PROPRIETOMPARTNERIEXECI.MVE YIN
<br />OFFICEMEMEEFUEXCLUDED?
<br />(Mandatory in NH)
<br />If yes, describe under DESCRIPTION OF
<br />OPERATION below
<br />NIA
<br />EL EACH ACCIDENT
<br />1,000,000
<br />E.L. DISEASE - E�EMP�OYEE
<br />E.L. DISEASE -POLICY LIMIT
<br />1,000,000
<br />DESCRIFPON OF OPERATIONSADCATIONSNEHICLES (Allach ACORD 101, Addilional Remarks Sclhedu€e, if more space is required)
<br />RE: Job #IR-15103 On -Call Engineering Services
<br />The City of Santa Ann, its officers, eruiployce%, agents,, volunteers and representatives are named as additional Insured per attached CG20101001
<br />endorsement attached. Additional Insured Endorsement attached.
<br />Waiver of Subrogation applies to General Liability and Workers' Compensation per attached endorsements. Insurance is Primary and Non-
<br />Coutriburory.
<br />THIS INSURANCE 16 PRIMARY. ANY OTHER INSURANCE AVAILABLE TO THAT PERSON OR OROANIZATION IS EXCESS AND NON-CONTRIBUTORY WHEN REQUIRED BY CONTRACT,
<br />NOTE- 30 DAYS NOTICE OF CANCELLATION WILL BE GIVEN EXCEPT 10 DAY FOR NO,N-PAYMENT.
<br />CERTIFICATE HOLDER CANCELLATION
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
<br />EXPIRATION DATE THEREOF, NOTlCE WILL BE DELIVERED N ACCORDANCE WI -I H
<br />THE POLICY PROVISIONS
<br />City of Santa Ana
<br />20 Civic Center Plaza AUTHORIZED REPRESENTATIVE
<br />Santa Ann, CA 92702
<br />Z—ORD 25 (L014101) The ACORD name and bio are!CORPORATION AAN tits reserved
<br />
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