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ACCOR� CERTIFICATE OF LIABILITY INSURANCE
<br />INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERN[ 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 />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
<br />CLcRTIFICATS DOES NOT AFFIRMATIVELY OR NEGATIVELY AUSND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
<br />BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER($), 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 poilcy, certain policies may require an endorsement. A statement on this certificate does not confer rlghts to the
<br />certificate holder In lieu of such endorsement(s).
<br />PRODUCER
<br />CO C Mo11y McCarthy
<br />NA
<br />ONE (S03) 941-BDIS
<br />Emery & Karrigan Inc.
<br />17933 N4? Evergreen Parkway
<br />B, J004icav6smerykarrigran.Rom
<br />'R-Uite 350
<br />Beaverton OR 97006
<br />INSURERS APPORDINGCOV11RAGE NAC0
<br />I SURERA,CQlon Inssuran Cm ori 9993
<br />INSURED RCS Safety LLC
<br />lNisugEga Admiral Insurance Gam_ an 24856
<br />digs: Roadway Construction Service
<br />INS sRC',S0 sht0da1e Insurance CogpWw 41.297
<br />12731 Los Nietol3 Rd.
<br />I ER Midwest Mp—laarg Casustlty Co. 23612
<br />INSURER 8 I
<br />INSU ERFI
<br />Santa Fa Springs CK 90670
<br />COVERAC+ES CERTIFICATE NLIMSFR! RNWIRIAN NIIAArtga.
<br />THIS i8 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, TERN[ 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 />eR
<br />OFINBURANCe
<br />ADDLTYPE
<br />20 Civio Ce -Ater Plfasa
<br />LI YNUM52R
<br />c
<br />crf? P
<br />LIMITS
<br />Rick Emmy/W ✓ %�f ----- -�-
<br />OFNERALLIA31LITY
<br />EACHCCCURRENCE 1 000,000
<br />A
<br />x COMMERCIAL GENERALLIABILMY
<br />CLAWS -MADE 7 nacuR
<br />X
<br />OAMAQE IuKtN I ku � 100,000
<br />MED FNP An one arson) 1 5,000
<br />108 GL 0003127-03
<br />3/27/2016
<br />3/27/2017
<br />PERSONAL& ADV INJURY 2,000,000
<br />GENERAL AGGREGATE $ 2,000,000
<br />OaN'LAGGR50ATELIMITAPPLIES PER
<br />PRODUCTS •COMMOPAGO S 2 000,000
<br />POLICYK PRC 11 LCC
<br />I
<br />$
<br />AUTOMOBILE
<br />LIABILITY
<br />EMB0
<br />ANY AUTO
<br />BODILY INJURY (Porperton) W 3
<br />ALLOWN50 SOK-DULCO
<br />AUTOS AUTOS
<br />NNW
<br />HIREDAR
<br />H$
<br />BODILY (PersaeidakI $
<br />pal$
<br />X
<br />UMBRELLA LIARX
<br />OCCUR
<br />EACHOCCURRENCE s 10,000,000
<br />EKCESSLIAB
<br />CLAIMB•MADS
<br />AXODOOO140
<br />3/27/2016
<br />3/97/2017
<br />AGGREGATE $ 10,000,000
<br />E6 1. x I RETENTION
<br />$
<br />X
<br />WORORS COMPENSATION
<br />AND EMPl0YER3' LIABILITY
<br />ANY PROPRIETOR1PARTNERIEX50UYiVE�
<br />OFFICERIMEM6ER EXCLVDB07
<br />(Mandatory In NH)
<br />if yoa descdhe under
<br />DRIPTION O.P OPERATIONS balm
<br />NIA
<br />BNO4rC41S6188
<br />5/09/2016
<br />s/04/2027
<br />C e •
<br />ATU- DTH-
<br />gL,EACHAC_CI_DENT 1 04 c00
<br />R,L. DISEASES - kA EMPLOYE 0 1,_Q00, 00
<br />El, DISEASE . POLICY LIMIT $ 1 000 000
<br />13
<br />P>;ofossional Liability
<br />7;0400022268-04
<br />3/27/2416
<br />3/27/2017
<br />EachClalm 1,400,000
<br />Claims made
<br />Retro Date 03/27/13
<br />ASBragale 1.,000,000
<br />DESCRIPTION OF OPERATIONS! LOCATIONS !VEHICLES (Attach ACCRD 101, Additional RQmaiks Schedule, If moro space le required)
<br />The City of Santa Ana, Its Officers, Blayloyees and Volunteers are reamed as additional insured per the
<br />attached, Coverage is primary none-oontributory pow the attached. 30 day notice of na.naellat:ion.
<br />�
<br />REVIEWED SY: EUNIICE HEREPIA (PG I OF��
<br />CERTIFICATE HOLDER tIANI PI 1 ATInk!
<br />AI;UKU 60 t6U'IVJV0) (M 1988Q010 AGORD CORPORATION. All rlghtn reaarvad.
<br />IN S025 r2nlllnR) m The, Afr)Wn nnrno and Innn rtra ranlafnrael mar4c of Ar nr?n
<br />SHOULD ANY OF THE ABOVE DESCRIBED POIJOISS BE CANCELLED BEFM
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE. DELIVERED IN
<br />City ski' Santa Ana., X-93
<br />ACCORDANCE WIT'H THR POLICY PROVISIONS.
<br />20 Civio Ce -Ater Plfasa
<br />AUTHORIZOD0PRESENTATIVE
<br />Santa Ana, Ch 92702
<br />Rick Emmy/W ✓ %�f ----- -�-
<br />AI;UKU 60 t6U'IVJV0) (M 1988Q010 AGORD CORPORATION. All rlghtn reaarvad.
<br />IN S025 r2nlllnR) m The, Afr)Wn nnrno and Innn rtra ranlafnrael mar4c of Ar nr?n
<br />
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