|
Page 1 of 2
<br />~
<br />" CERTIFICATE ®F LIABILITY INSURANCE
<br />OS/29/201DATE (MM/DD/YY
<br />7
<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 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 />Willis of Minnesota, Inc.
<br />c/o 26 Century Blvd
<br />P.O. Box 305191
<br />CONTACT
<br />NAME:
<br />PHONE 1-877-945-7378 FAX 1-888-467-2378
<br />C No Ext : (A/C No1:
<br />_
<br />E-MAIL certificates@willis.com
<br />ADDRESS:
<br />INSURER(S) AFFORDING COVERAGE
<br />NAIC#
<br />Nashville, TN 372305191 USA
<br />INSURER A: Liberty Mutual Insurance Company
<br />23043
<br />INSURED
<br />HDR Engineering, Inc.
<br />INSURER B :
<br />-------- --- ---
<br />--
<br />8404 Indian Hills Drive
<br />INSURER C :
<br />INSURER D :
<br />Omaha, NE 68114
<br />INSURER E :
<br />INSURER F :
<br />COVERAGES CERTIFICATE NUMBER: W2352173 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 />ILTR
<br />TYPE OF INSURANCE
<br />A.SDDDL
<br />SUBR
<br />POLICY NUMBER
<br />MM DD/POLICYYYYY
<br />MM DDIYYYY POLICY EXP
<br />LIMITS
<br />X
<br />COMMERCIALGENERALLIABILITY
<br />CLAIMS-MADE1XI OCCUR
<br />EACH OCCURRENCE
<br />$ 2,000,000
<br />DAMAGE TO RENT ,'
<br />PREMISES Ea occurrence
<br />$ 1, 000 , 000
<br />_
<br />MED EXP (Any one person)
<br />$ 10,000
<br />A
<br />Y
<br />Y
<br />TB2-641-444950-037
<br />06/01/2017
<br />06/01/2016
<br />PERSONAL & ADV INJURY
<br />$ 2,000,000
<br />AGGREGATE LIMIT APPLIES PER:
<br />POLICY � JE LOC
<br />GENERAL AGGREGATE
<br />$ 4,000,000
<br />GEN'L
<br />_ PRODUCTS - COMP/OP AGG
<br />_
<br />4,000,000
<br />_$
<br />$
<br />OTHER:
<br />AUTOMOBILE
<br />LIABILITY
<br />COMBINED SINGLE LIMIT
<br />Ea accident
<br />$ 2,000,000
<br />X
<br />ANY AUTO
<br />BODILY INJURY (Per person)
<br />$
<br />A
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />N
<br />N
<br />AS2-641-444950-047
<br />06/01/2017
<br />06/01/2018
<br />BODILY INJURY (Per accident)
<br />$
<br />HIRED NON -OWNED
<br />AUTOS ONLY AUTOS ONLY
<br />PROPERTY DAMAGE
<br />Per accident
<br />_
<br />$
<br />A
<br />X
<br />UMBRELLA
<br />X
<br />OCCUR
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />AGGREGATE
<br />$ 1,000,000
<br />EXCESS LAB
<br />CLAIMS -MADE
<br />N
<br />N
<br />TH7-641-444950-067
<br />06/01/2017
<br />06/01/2018
<br />DED I I RETENTION $
<br />$
<br />A
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY Y / N
<br />FFCER/M MB REXCLUDED7ECUTIVE No
<br />N/A
<br />N
<br />WA7-64D-444950-017
<br />06/01/2017
<br />06/01/2018
<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 />(Mandatory in NH)
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE - POLICY LIMIT
<br />$ 1,000,000
<br />A
<br />Workers Compensation N N WC7-641-444950-027 06/01/2017 06/01/2018
<br />Each Accident:
<br />1,000,000
<br />and Employers Liab. - ,a,
<br />REVIEWED BY: I " EUNICEHEREDIA(PG �0F
<br />Per Statute
<br />Disease - Pol Limit:
<br />Disease - Ea. Emp1:
<br />1,000,000
<br />1,000,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
<br />EMPLOYERS LIABILITY FOR THE MONOPOLISTIC STATES OF ND, OH, WA, & WY IS PROVIDED IN THE WORKER'S COMPENSATION POLICY.
<br />CITY OF SANTA ANA - ON CALL RIGHT OF WAY COORDINATOR (REP 16-141). CITY OF SANTA ANA, ITS OFFICERS, EMPLOYEES, AGENTS,
<br />VOLUNTEERS AND REPRESENTATIVES ARE INCLUDED AS ADDITIONAL INSUREDS AS RESPECTS TO GENERAL, LIABILITY. THE GENERAL
<br />LIABILITY POLICY SHALL BE PRIMARY AND NON-CONTRIBUTORY WITH ANY OTHER INSURANCE IN FORCE FOR OR WHICH MAY BE PURCHASED
<br />BY THE ADDITIONAL INSUREDS.WAIVER OF SUBROGATION APPLIES IN FAVOR OF THE ADDITIONAL INSUREDS WITH RESPECTS TO GENERAL
<br />a. M r IF Il m r c "W"UIZrc UANI MLLA I IUN
<br />CITY OF SANTA ANA
<br />ATTN: MARIA D. HUIZAR
<br />20 CIVIC CENTER PLAZA (M-30)
<br />PO BOX 1988
<br />SANTA ANA, CA 92702-1988
<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 />AUTHORIZED
<br />REPRESENTATIVE
<br />©1988-2015 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
<br />SR ID: 14647678 BATCH: 333625
<br />
|