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<br />A� " CERTIFICATE OF LIABILITY INSURANCE
<br />DATE(MM/ 2018Y)
<br />O5/18/018
<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 />PHONE FAX
<br />C No Ext: 1-877-945-7378 (A/C No; 1-688-467-2378
<br />E-MAIL
<br />DSS: certificates@Willis.com
<br />INSUREI AFFORDING COVERAGE
<br />NAIC#
<br />Nashville, TN 372305191 USA
<br />INSURER A: Liberty Mutual Fire Insurance Company
<br />23035
<br />INSURED
<br />INSURERS; Liberty Insurance Corporation
<br />42404
<br />HDR Engineering, Inc.
<br />8404 Indian Hills Drive
<br />INSURER C;
<br />INSURER D:
<br />Omaha, NE 68119
<br />INSURER E
<br />INSURER F :
<br />COVERAGES CERTIFICATE NUMBER: W6237880 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 />ADDLSUBR
<br />INSD
<br />WVQ
<br />POLICY NUMBER
<br />MMIDDNYYY
<br />MM/DD/YYYY
<br />LIMITS
<br />X
<br />COMMERCIALGENERALLIABILITY
<br />CLAIMS -MADE ® OCCUR
<br />EACH OCCURRENCE
<br />$ 2,000,000
<br />PREMIES( RENTED
<br />PREMISES Ea occurrence
<br />$ 1,000,000
<br />X
<br />MED EXP (Any one person)
<br />$ 10,000
<br />A
<br />Contractual Liability
<br />Y
<br />Y
<br />TB2-641-444950-038
<br />06/01/2018
<br />06/01/2019
<br />PERSONAL & ADV INJURY
<br />$ 2,000,000
<br />AGGREGATE LIMIT APPLIES PER:
<br />GENERAL AGGREGATE
<br />$ 4,000,000
<br />GEN'L
<br />POLICY 1 PE� [X]LOC
<br />PRODUCTS - COMP/OP AGG
<br />$ 4,000,000
<br />$
<br />OTHER:
<br />AUTOMOBILE
<br />LIABILITY
<br />COMBINED SINGLE LIMIT
<br />Ea accident
<br />$ 2,000,000
<br />BODILY INJURY (Per person)
<br />$
<br />X
<br />ANY AUTO
<br />A
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />Y
<br />Y
<br />AS2-641-444950-048
<br />06/01/2018
<br />06/01/2019
<br />BODILY INJURY (Per accident)
<br />$
<br />AUTOS ONLY AUTOS ONLY ED NON -OWNED
<br />L
<br />PROPERTY DAMAGE
<br />Per accident
<br />$
<br />$
<br />I
<br />i
<br />B
<br />X
<br />UMBRELLALIAB
<br />X
<br />OCCUR
<br />EACH OCCURRENCE
<br />$ 5,000,000
<br />AGGREGATE
<br />$ 5,000,000
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />Y
<br />Y
<br />TH7-641-444950-068
<br />06/01/2018
<br />06/01/2019
<br />DED I I RETENTION $
<br />$
<br />B
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY
<br />ANYPROPRIETOR/PARTNER/EXECUTIVE YIN
<br />OFFICER/MEMBEREXCLUDED7 No
<br />(Mandatory In NH)
<br />NIA
<br />Y
<br />WA7-69D-494950-018
<br />06/tl1/2018
<br />06/01/2019
<br />X STATUTE ORH
<br />E.L. EACH ACCIDENT
<br />$ 1,000,000
<br />E.L. DISEASE - EA EMPLOYEE
<br />$ 1,000,000
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE - POLICY LIMIT
<br />$ 1,000,000
<br />REVIEWED BY
<br />TT
<br />PCB t OF 14) ny
<br />EUNICE HEREDIA
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required)
<br />Certificate Holder is named as Additional Insured on General Liability, Automobile Liability and Umbrella Liability on
<br />a primary, non-contributory basis where required by written contract. Waiver of Subrogation applies on General
<br />Liability, Automobile Liability, Umbrella Liability and Workers Compensation where required by written contract.
<br />Umbrella policy follows form of the underlying General Liability, Automobile Liability, Employers Liability.
<br />CITY OF SANTA ANA - ON CALL RIGHT OF WAY COORDINATOR (RFP 16-141).
<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 />UANUtLLAI IUN
<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 REPRESENTATIVE
<br />may.
<br />U 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: 16178775 BATCH: 715012
<br />
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