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'NATIONAL DATA AND SURVEYING SERVICES A -2013 -169 REVIEWFD BY .Fd It FuNICE HF-RFn1A IPr, I nF 91
<br />aCxWH CERTIFICATE OF
<br />LIABILITY Nr$�URANCE
<br />9 /24 /2015D /YYVY)
<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(losj must be endorsed. If SUBROGATION IS WAIVED, subject to
<br />the terms and conditions of the policy, certain policies may requlre an endorsement. A statement on this certificate does not confer rights to the
<br />certificate hostler in fieu of such endorsements .
<br />PRODUCER
<br />ROSEWOOD RISK'MGMT 6 INS SOLUTIONS
<br />-7162 Beverly Blvd, Ste 180
<br />Los - Angeles, CA 90036
<br />OR38577
<br />A Yehuda Kaplan
<br />PRoNE 323) 899 -3081 A..NO1:(323) eeD -6745
<br />Yycap anrrrmis.aam
<br />_
<br />INSURERS AFFORDING COVERAGE
<br />NAICM
<br />INSURER, Penn Starr Insurance Company
<br />10673
<br />INSURED National Data and Surveying Services
<br />8370 Wilshire Blvd., Ste 205,
<br />Beverly Hills, CA 90211
<br />(323) 782 -0090
<br />COMMERCIAL GENERAL LIABILITY
<br />wsORERB. west xmurtcan Ina. C..(Lib—ty Wotaai)
<br />44393
<br />Torus Insurance Company
<br />25496
<br />w �National
<br />JNSURERp, Zurich Rmerioan Insurance Company
<br />16535
<br />EBE
<br />NISURERF-
<br />cnvc'eArr Q
<br />naDTICV`ATC. Nil II
<br />on, nc,nel nu junco.
<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 BYPAID CLAIMS.
<br />LTR
<br />- TYPE OF INSURANCE
<br />_
<br />POLICY E
<br />I POLICY XI+
<br />LIMITS
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />EACH OCCURRENCE
<br />11000,000
<br />CLAIMS -MADE OCCUR
<br />P r r'lmnfPl
<br />$ 100,200
<br />MET, EXPIAn anenermn)
<br />$ _,000
<br />CPVO 007042 (CA,WA, TN)
<br />9/17/159(17/16
<br />A
<br />Y
<br />Y
<br />PAV0054346 (GA, FL NOT
<br />PERSONAL B ADV INJURY
<br />S 1,000,000
<br />GEN'L AGGREGATE LIMITAPPLIES PER:
<br />GENERAL AGGREGATE
<br />$ 2,000,000
<br />POLICYO JEC C T ®_LOC
<br />PRODUCTS - COMP /OP AGG
<br />$ Included
<br />Ded.
<br />$ 2,500
<br />AUTOMOBILELIARILITY
<br />COMBINED SINGE
<br />$ 1,
<br />'DOILY INJURY (Per Person)
<br />$
<br />SAW 116) 56 86 53 13
<br />9/17/159/17/16
<br />B
<br />JXANYAUTO
<br />A SCHEDULED
<br />R
<br />AUTOS O Auros
<br />Y
<br />Y
<br />BODILY INJURY(Peraccidenl)
<br />$
<br />NON-OWNED
<br />HIREDAU'rOG R AUTOS
<br />-
<br />PROPERTY DAMAGr
<br />nr ren
<br />$
<br />X
<br />UMBRELLA LAB
<br />$
<br />OCCUR
<br />EACH OCCURRENCE
<br />$ 9,500,000
<br />AGGREGATE
<br />$ 51 1
<br />(J
<br />EXCESS LAB
<br />CLAIMS -MADE
<br />Y
<br />Y
<br />_
<br />77763H152ALI :
<br />9/17/15
<br />D
<br />r 10 000
<br />WORKERS COMPENSATION
<br />$ PE TH,
<br />STA Ind MEN
<br />AND EMPLOYERS' LIABILITY
<br />ANY PR(MEAIBERRiPARTN RIENECUTIVE Y
<br />WC 9407597 -02
<br />9/17/1
<br />9/17/16
<br />ELEACH CCIDENT
<br />S 1,000, 000
<br />D
<br />NIA
<br />Y
<br />EI..DISEASF- EAEMPLOYEC
<br />$ 1 1
<br />(Mmellmry in NR)
<br />IfE 64ascnaeunder Sb l
<br />S -,P f
<br />1,000,000
<br />Commercial GL
<br />Per Occ: $1,000,000
<br />A
<br />PAV0054346
<br />Y
<br />Y
<br />PAV0054346
<br />9/17/159/
<br />17/16Gen
<br />Agg: $2,000,000
<br />Outside (CA)
<br />DESCRIPTION OF OPERATIONS /LOCATIONS !VEHICLES (AGGRO 101. Atltlltional Remarks SChadulu, may be aliachadiT more space is reyalredf
<br />CITY OF SANTA ANA PUBLIC WORKS its officers, employees, and agents are provided
<br />additional insured status on a primary and noncontributory basis as required by
<br />written contract or agreement. A Waiver of Subrogation is in favor of the
<br />additional insured.
<br />30 Days Notice of Cancellation, 10 Days for Non Payment of Premium.
<br />CITY OF SANTA ANA PUBLIC WORKS I SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />20 CIVIC CENTER PLAZA THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />SANTA ANA, CA 92701 ACCORDANCE WITH THE POLICY PROVISIONS.
<br />AUTNOmLEL% RUPRESE.N'LATIVE
<br />@1988 -2014
<br />k\UUKU 2b (YeulglU'1) 1 ne AUUMU name and logo are registered marks of AGURD
<br />All rights reserved.
<br />
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