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CERTIFICATE OF LIABILITY INSURANCE
<br />DATE(MMI00/VYYY)
<br />D71282D,E
<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 have ADDITIONAL INSURED provisions or be endorsed.
<br />If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on
<br />this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
<br />PRODUCER
<br />AOn Risk Services Central, Inc.
<br />Pittsburgh PA Office
<br />CONTACT
<br />NAME:
<br />_
<br />(PJC NNo. Ext): (866) 283-7122____NoJ: (800) 363-0105
<br />Dominion Tower, 10th Floor
<br />625 Liberty Avenue
<br />Pittsburgh PA 15222-3110 USA
<br />EMAIL
<br />ADDRESS:
<br />INSURER(S) AFFORDING COVERAGE
<br />NAICk
<br />INSURED
<br />INSURER A: Liberty Mutual Fire Ins CO
<br />23035
<br />Michael Baker International, Inc.
<br />PO BOX 57057
<br />Irvine CA 92619-7057 USA
<br />INSURER B: Liberty Insurance corporation
<br />42404
<br />INSURER C: National Union Fire Ins COO -Pittsburgh
<br />19445
<br />INSURER D: Lloyd's syndicate No. 2623
<br />AA1128623
<br />NSURER E:
<br />INSURER F:
<br />COVERAGES CERTIFICATE NUMBER: 570063228283 REVISION NUMBER:
<br />THIS 15 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. Limits shown are as requested
<br />TR
<br />TYPE OF INSURANCE
<br />ADDISUDR
<br />WVD
<br />POLICY NUMBER
<br />POLD YF
<br />MMIDODOIYYYV
<br />LIMITS
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />B
<br />EACH OCCURRENCE
<br />$2,000,000
<br />CLAIMS -MADE M OCCUR
<br />PREMISES IS. o..m noe
<br />$1.000,000
<br />X
<br />MED EXP(Any one person)
<br />$5,000
<br />Contractual UamIlly
<br />PERSONAL &ADV INJURY
<br />$2,000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER
<br />JECTPRO_
<br />POLICY ❑X F% LOG
<br />GENERALAGGREGATE
<br />$4,000,000
<br />PRODUCTS -0OMPIOP AGO
<br />$4, 000, 000
<br />OTHER:
<br />A
<br />AUTOMOBILE LIABILITY
<br />A52-681-004145-725
<br />08/30/201508/302016
<br />COMBINED SINGI.ELINIIT
<br />a de t
<br />$2,000,000
<br />BODILY INJURY( Per person)
<br />% ANY AUTO
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />HIREOAUTOS NON -OWNED
<br />ONLY AUTOS ONLY
<br />BODILY INJURY (Per acddan)
<br />PROPERTY DAMAGE
<br />Paracoklmr
<br />C
<br />X
<br />UMBRELLALIAD
<br />X
<br />OCCUR
<br />BE0330 3
<br />0 /30/2015
<br />08/ 0 2016
<br />EACH OCCURRENCE
<br />$10,000,000
<br />EXCESS UAB
<br />CLAIMS -MADE
<br />AGGREGATE
<br />$10,000,000
<br />CEO I X RETENTUN$10, 000
<br />B
<br />B
<br />WORKERS COMPENSATION AND
<br />EMPLOYERS' LIABILITY YIN
<br />ANY PROIMEM ERI PARrNERi EXECUTIVE �
<br />OFFR (Mandatory In NH)
<br />DESCRIPTIION OF OPERATIONS below
<br />N i A
<br />WA768DO04145779
<br />ADS
<br />WC7681004145785
<br />WI
<br />08/30 2015
<br />08/30/2015
<br />0 30 2016
<br />08/30/2016
<br />X PER OTH-
<br />STATUTE ER
<br />E.L. EACH ACCIDENT
<br />$1,000,000
<br />E.L. DISEASE EA EMPLOYEE
<br />$1,000,000
<br />E,L.DISEASE-1'+OLICY LIMIT
<br />$1,000,000
<br />o
<br />E&O-PL-Primary
<br />QC1502675
<br />08/31/2015
<br />O8/31/2016
<br />Per Claim
<br />$5, 000,000
<br />Professional & Pollution
<br />Aggregate
<br />$5, 000, 000
<br />SIR applies per policy ter
<br />s & condi.ions
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Ie required)
<br />For Named Insured Only: Kim Hartsfield. RE: Project Name: Agreement Numbers A-2016-093 & A-2015-170. City of Santa Ana,
<br />its officers, employees, agents and representatives are included as Additional Insured in accordance with the policy provisions
<br />of the General Liability policy. General Liability evidenced herein is Primary and Non-contributory to other insurance
<br />available to an Additional Insured, but only in accordance with the policy's provisions. Should General Liability, Automobile
<br />Liability and Workers' Compensation policies be cancelled before the expiration date t ere gg the policy provisions will govern
<br />how notice of cancellation may be delivered to certificate Holders in accordance with h Giicy provisions of each policy.
<br />REVlGWED BY EUN(CE t1EREDIA,(PG OF )
<br />CERTIFICATE HOLDER
<br />CANCELLATION
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
<br />EXPIRATION DATE THEREOF, NOTICE WILL BE
<br />DELIVERED IN ACCORDANCE WITH THE
<br />POLICY PROVISIONS,
<br />City
<br />of Santa Ana
<br />AUTHORIZED REPRESENTATIVE
<br />Attn:
<br />Ross Annex
<br />20 Civic center Plaza,PO aox 1988
<br />Santa Ana en 92702-1988 USA
<br />%niL9 0
<br />©1988.2015 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD
<br />
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