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<br />ACC)RV CERTIFICATE OF LIABUTY INSURANCE
<br />°06/18/2 9Y'
<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 />CONTACT
<br />NAME•
<br />Willis Towers Watson Midwest, Inc. fka Willis of Minnesota, Inc.
<br />c/o 26 Century Blvd
<br />P.O. Box 305191
<br />PHONE 1-877-945-7378 FAX 1-858-467-2378
<br />Extl: CNo:
<br />ADDRESS: certificates@willis.com
<br />INSURERS AFFORDING COVERAGE
<br />NAIC #
<br />Nashville, TN 372305191 USA
<br />INSURERA: Liberty Mutual Fire Insurance Company
<br />23035
<br />INSURED
<br />HDR Engineering, Inc.
<br />1917 South 67th Street
<br />INSURERB: Ohio Casualty Insurance Company
<br />24074
<br />INSURERC: Liberty Insurance Corporation
<br />42404
<br />1 INSURER D
<br />Omaha, NE 68106
<br />INSURER E
<br />INSURER F :
<br />COVERAGES CERTIFICATE NUMBER: W11649339 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 />LTR
<br />TYPE OF INSURANCE
<br />A
<br />D
<br />POLICY NUMBER
<br />POLICY EFF
<br />DD1
<br />POLICY EXP
<br />MM/DD/YYYY
<br />LIMITS
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />EACH OCCURRENCE
<br />$ 2,000,000
<br />CLAIMS -MADE Fx_] OCCUR
<br />GE TO RENTED
<br />PREMISES Eso9_Lurre
<br />$ 1,000,000
<br />X
<br />MED EXP (Any oneperson)
<br />$ 10,000
<br />A
<br />Contractual Liability
<br />Y
<br />Y
<br />TB2-641-444950-039
<br />06/01/2019
<br />06/01/2020
<br />PERSONAL & ADV INJURY
<br />$ 2,000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />GENERAL AGGREGATE
<br />$ 4,000,000
<br />POLICYJECO-- [X LOC
<br />PRODUCTS-COMP/OPAGG
<br />$ 4,000,000
<br />OTHER,.$
<br />AUTOMOBILE LIABILITY
<br />COMBINED SI GLE LIMIT
<br />Ea acci enl
<br />$ 2,000,000
<br />BODILY INJURY (Per person)
<br />$
<br />X ANY AUTO
<br />A
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />Y
<br />Y
<br />AS2-641-444950-049
<br />06/01/2019
<br />06/01/2020
<br />BODILY INJURY (Per accident)
<br />$
<br />PROPERTY DAMAGE
<br />Per ac *on)
<br />$
<br />HIRED NON -OWNED
<br />AUTOS ONLY AUTOS ONLY
<br />$
<br />B
<br />UMBRELLA LIAB
<br />X
<br />OCCUR
<br />EACH OCCURRENCE
<br />$ 5,000,000
<br />AGGREGATE
<br />$ 5,000,000
<br />X
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />Y
<br />Y
<br />EUO(20) 57919363
<br />06/01/2019
<br />06/01/2020
<br />JDEDL I RETENTION
<br />$
<br />C
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY YIN
<br />ANYPROPRIETOR/PARTNER/EXECUTIVE
<br />OFFICER/MEMBEREXCLUI No
<br />(Mandatory in NH)
<br />NIA
<br />Y
<br />WA7-64D-444950-019
<br />06/01/2019
<br />06/01/2020
<br />X PER TH-
<br />STATUTE ER
<br />E.L. EACH ACCIDENT
<br />$ 1,000,000
<br />E.L. DISEASE - EA EMPLOYE
<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 />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be 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 C O INATOR (RFP 16-191).
<br />Irr
<br />CERTIFICATE HOLDER L K, nL CANCELLATION
<br />City of Santa Ana Risk
<br />Risk Management Division
<br />20 Civic Center Plaza
<br />aanca a a, l 7z / VG
<br />Bement Dlvislon
<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 />q>Q"eke
<br />v
<br />©1988-2016 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
<br />sR In: 18129978 BATCH: 1247549
<br />
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