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AV�CERTIFICATE OF LIABILITY INSURANCE <br />7/2M/2016 <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 />Emery & Karrigan Inc. <br />NAMEACT Molly McCarthy <br />PHONE F No, (503)941^8018 <br />17933 NW Evergreen Parkway <br />ADDRESS: jess:Lcav@emerykarrigan.com <br />INSURERS AFFORDING COVERAGE NAIC# <br />Suite 350 <br />INSURERA:Colony Insurance Company 39993 <br />Beaverton OR 97006 <br />INSURED RCS Safety LLC <br />INSUREfts Admiral Insurance Company 4656 <br />INSURERC:Scottsdale Insurance Company 41297 <br />dba: Roadway Construction Service <br />INSURER D'Midwest Employers Casualty Co. 23612 <br />12731 Los Nietos Rd. <br />INSURER E: <br />1 INSURER F: <br />Santa Fe Springs CA 90670 <br />COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: <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 />TYPE OF INSURANCE <br />ADDLSUBR <br />wynP <br />LICYNUMBER <br />POLICY EFF <br />POLICY EXP <br />D <br />LIMITS <br />GENERAL LIABILITY <br />EAACHOCCURRENCE $ 1,000,000 <br />A <br />X COMMERCIAL GENERAL LIABILITY <br />CLAIMS -MADE a OCCUR <br />X <br />DAMAGE 11 REIT1 <br />PREMISES E. occur.enc $ 100,000 <br />MED EXP (Any one person) $ 5,000 <br />103 GL 0003127-03 <br />3/27/2016 <br />3/27/2017 <br />PERSONAL &ADV INJURY $ 1,000,000 <br />GENERAL AGGREGATE $ 2,000,000 <br />GEN'LAGGREGATE LIMIT APPLIES PER <br />PRODUCTS -COMPIOPAGG $ 2,000,000 <br />POLICY X PRO LOG <br />$ <br />AUTOMOBILE <br />LIABILITY <br />COMBINED SINGLE LIMIT <br />Es accident <br />_ <br />BODILY INJURY (Per person) $ <br />ANY AUTO <br />ALLOWNED SCHEDULED <br />AUTOS AUTOS <br />NON -OWNED <br />HIRED AUTOS AUTOS <br />BODILY INJURY (Per accident) $ <br />PROPERTY tDAMAGE <br />$ <br />X <br />UMBRELLA LIARX <br />OCCUR <br />EACH OCCURRENCE $ 10,000,000 <br />AGGREGATE $ 10,000,000 <br />L <br />EXCESS LIAB <br />CLAIMS -MADE <br />AXS0000740 <br />3/27/2016 <br />3/27/2017 <br />DED I X I RETENTION <br />$ <br />X <br />D <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY- <br />ANY PROPRIETORIPARTNER/EXECUTIVE� <br />OFFICER/MEMBER EXCLUDED? <br />(Mandatory in NH) <br />NIA <br />BNOWC0135188 <br />5/04/2016 <br />5/04/2017 <br />X I WC STATU- I OTH- <br />ER <br />EL EACH ACCIDENT $ 1,000,000 <br />E.L. DISEASE -EA EMPLOYE $ 1,000,000 <br />If yes, describe under <br />DESCRIPTION OF OPERATIONS below <br />E.L. DISEASE - POLICY LIMIT $ 1,000,000 <br />B <br />Professional Liability <br />E0000022268-04 <br />3/27/2016 <br />3/27/2017 <br />Each Claim 1,000,000 <br />Claims Made <br />Retro Date 03/27/13 <br />Aggregate 1,000,000 <br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) <br />The City of Santa Ana, its Officers, Employees and Volunteers are named as additional insured per the <br />attached. Coverage is primary non-contributory per the attached. 30 day notice of cancellation. <br />FiEYA El_ +!( [) l3Y EUNK E HEREDIA (PC teal ) y) <br />CERTIFICATE HOLDER CANCELLATION <br />ACORD 25 (2010105) <br />INS025 nninns) n1 <br />©1988-2010 ACORD CORPORATION. All rights reserved. <br />The tlP(lRit nnma nnrl Innn am ranicfnrnrl mnr4e of tlrnpn <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />City of Santa Ana, M-93 <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />20 Civic Center Plaza <br />AUTHORIZED REPRESENTATIVE <br />Santa Ana, CA 92702 <br />Rick Emery/LTV <br />ACORD 25 (2010105) <br />INS025 nninns) n1 <br />©1988-2010 ACORD CORPORATION. All rights reserved. <br />The tlP(lRit nnma nnrl Innn am ranicfnrnrl mnr4e of tlrnpn <br />