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A�C"R" CERTIFICATE OF LIABILITY INSURANCE
<br />04/26/20 6 YY�
<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 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 />PRODUCER
<br />CONTACT
<br />NAME:
<br />Marsh USA Inc., Multinational Incoming Unit
<br />a service of Seabury and Smith, Inc.
<br />9830 Colonnade Boulevard, Suite 400
<br />PHONE FAX
<br />A/C No Ext:210-691-9100 A/C No:210-737-3584
<br />E-MAIL
<br />ADDRESS:
<br />INSURERS AFFORDING COVERAGE
<br />NAIC#
<br />PO Box 659520
<br />San Antonio, TX 78265-9520
<br />INSURER A: FEDERAL INSURANCE CO
<br />20281
<br />INSURED
<br />INSURER B: CHUBB INS CO OF CANADA
<br />Kapsch TrafficCom Transportation NA, Inc
<br />INSURER C:ACE American Insurance Co
<br />22667
<br />8201 Greensboro Drive
<br />McLean, VA 22102
<br />INSURERD:
<br />INSURER E:
<br />INSURER F :
<br />I04011T171L111n 3. Fl=rag In IMA\r=dnNutl_1=!,]d1/Ly r615■\IIIJ,Ie73
<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 BY PAID CLAIMS.
<br />INSR
<br />LTR
<br />TYPE OF INSURANCE
<br />ADDL
<br />SUBR
<br />POLICY NUMBER
<br />POLICY EFF
<br />MMIDDIYYYY
<br />POLICY EXP
<br />MM/DDIYYYY
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE E OCCUR
<br />99991674
<br />;, a
<br />t.a,ovzala
<br />11./30/201c
<br />EACH OCCURRENCE
<br />$1, 000, 000
<br />PREM SES� a occu ence
<br />$1, 000, 000
<br />MED EXP (Any one person)
<br />$10 , 0 0 0
<br />PERSONAL &ADV INJURY
<br />$1, 000, 000
<br />GENT AGGREGATE LIM] T AP PLIES PER:
<br />GENERAL AGGREGATE
<br />$2,000,000
<br />X POLICY C PRO JECT ❑ LOC
<br />PRODUCTS - COMP/OP AGG
<br />$2, 000, 000
<br />$
<br />OTHER:
<br />A
<br />AUTOMOBILE
<br />LIABILITY
<br />73565101
<br />p4/011/-016
<br />11 /:30/2016
<br />B'NED
<br />CEa accidenOM.,d.ntSINGLE LIMIT
<br />$1,000,000
<br />X
<br />ANY AUTO
<br />BODILY INJURY (Per person)
<br />$
<br />ALL OWNED SCHEDULED
<br />AUTOS AUTOS
<br />BODILY INJURY (Per accident)
<br />$
<br />HIRED AUTOS NON -OWNED
<br />AUTOS
<br />PROPERTY DAMAGE
<br />Per accident
<br />$
<br />B
<br />X
<br />UMBRELLA LIAB
<br />X
<br />OCCUR
<br />79872350
<br />04/01/2016
<br />11130120.16
<br />EACH OCCURRENCE
<br />$5,000,000
<br />AGGREGATE
<br />$5, 0O0, 000
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />DED RETENTION $
<br />$
<br />A
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY YIN
<br />71751328
<br />04/01/2015
<br />_1/30;2616
<br />PER OTH-
<br />STATUTE ER
<br />E.L. EACH ACCIDENT
<br />$1, 000, 000
<br />ANY PROPRIETOR/PARTNER/EXECUTIVE
<br />D? OFFICER/MEMBER EXCLUDE
<br />N / A
<br />E.L. DISEASE - EA EMPLOYEE
<br />$1, 000, 000
<br />(Mandatory in NH)
<br />If yes, describe under
<br />DESCRIPl10N OF OPERATIONS below
<br />E.L. DISEASE -POLICY LIMIT
<br />$1, 000, 000
<br />C
<br />Professional
<br />E01MG25.590144003
<br />04101/2016
<br />.130/2016
<br />Limit 5,000,000
<br />E & 0
<br />Claims Made
<br />Aggregate 5,000,000
<br />Retro Data 06/01/11
<br />Retention In, 000
<br />DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
<br />Umbrella Liability policy 4 3,723'5C with Chubb C.cimpany of. ,anada was played Ly March Canaria Limited.
<br />Seabury & Smith, Inc. has only acted in the role off a consultant `o the client ith respecr to this placement which is placed
<br />here for your convenience.
<br />City of Santa Ana, PWA - Trrnsportat:ion & Tt:af:fi� Erigmeer.ing ❑epartment ar.. are -n_L"Id d as Additional. on the
<br />General Liability, Auto Liability and Umbrella Liability policies as required by written contract.
<br />Waiver of Subrogation is Lr favr_r if City t ant.i Ana, PWA f an..p� i`ian & Tra i trJLnr.. ing D2par.merit on the
<br />General Liability, Auto Liar tirnbrelli Liability and lw rkers compan.a.atron po_-_i-s -7r r. qu 3rrcl 1r, 1tten contrFc,,t.
<br />.-____.._.._....__....__..,... _ T.._.__._..__ _ _.....,____.._ ..._
<br />REVIi».WED B a' EUNI CE HE REDIA (PG nil--
<br />Vcm i Ir n-K I c I'IVLIJcm
<br />City of Santa Ana
<br />Attn: Vinh Nguyen, P.E., Sr. Civil Engineer
<br />PWA - Transportation & Traffic Engineering
<br />20 Civic Center Plaza
<br />Santa Ana, CA 92701
<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 />AUTHORI D REPRESENTATIVE
<br />0 bNa�,_kv
<br />©1988-2014 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD
<br />DS#66249591
<br />
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