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<br />ACC__>R" CERTIFICATE ®F LIABILITY INSURANCE
<br />DATE (MMIDDIYYYY)
<br />4/28/2017
<br />THIS CERTIFICATE 15 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 />Cavignac & Associates
<br />450 B Street, Suite 1800
<br />San Diego CA 92101
<br />NAME: Certificate Department
<br />PHM 619-744-0574 FAX. 619-234-8601
<br />E-MAIL ,certificates cavi nac.com
<br />@ g
<br />INSURER(S) AFFORDING COVERAGE NAIC #
<br />COMMERCIAL GENERAL LIABILITY
<br />INSURER A:.Liberty Insurance Cor oration 42404
<br />Y
<br />INSURED NV51NC0-01
<br />INSURERB:Travelers Property & Casualty Compa 25674
<br />NV5, Inc.
<br />INSURER C :The First Liberty Insurance Corpora
<br />15092 Avenue of Science, Suite 200
<br />San Diego, CA 92128
<br />INSURER D:Berkley Insurance Company.... -32603
<br />INSURER E:
<br />INSURER F
<br />COVERAGES CERTIFICATE NUMBER: 1402691839 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 />ADDL
<br />IND
<br />SUER
<br />VOVD
<br />POLICY NUMBER
<br />POLICY EFF
<br />MM1DDNYYY
<br />POLICY EXP
<br />MMlDWYYYY
<br />LIMITS
<br />B
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />Y
<br />Y
<br />680OH706339
<br />5/1/2017
<br />5/1/2018
<br />EACH OCCURRENCE $1,000,000
<br />CLAIMS -MADE � OCCUR
<br />PREMGETO RENTED a occurrence) $1,000,000
<br />X
<br />MED EXP (Any one person) $10,000
<br />Cross LIab1SBVln
<br />X
<br />$0Deduciible
<br />PERSONAL.&ADV INJURY $1,000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />GENERAL AGGREGATE_ $2,000,000
<br />X POLICY PRO-
<br />JECT F_X] LOC
<br />PRODUCTS - COMP/OP AGO $2,000,000
<br />Stop Gap LiabiUy $1,000,000
<br />OTHER:
<br />A
<br />AUTOMOBILE
<br />LIABILITY
<br />Y
<br />Y
<br />A87Z91462442027
<br />5/1/2017
<br />5/1/2018
<br />Ea axldent SINGLE
<br />T $1,000,000
<br />BODILY INJURY (Per person) $
<br />X
<br />ANY AUTO
<br />AUTOWNED SCHEDULED
<br />BODILY INJURY (Per accident) $
<br />HIRER AUTOS NON -OWNED
<br />AUTOS
<br />PROPERTY DAMAGE $
<br />Per accident
<br />A
<br />X
<br />UMBRELLA LIAR
<br />I X I OCCUR
<br />TH7Z91462442037
<br />5!112017
<br />5!112018
<br />EACH OCCURRENCE $10,000,000
<br />AGGREGATE $10,000,000
<br />EXCESS UAB
<br />CLAIMS -MADE
<br />DED X RETENTION$0
<br />$
<br />C
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY Y f N
<br />ANY PROPRIETOR/PARTNERIEXECUTIVE
<br />OFFICER/MEMBER EXCLUDED? N
<br />N 1 A
<br />y
<br />WC6Z91462442047
<br />511/2017
<br />511/2018
<br />RR R
<br />X STPEATUTE ETH -
<br />2
<br />E.L. EACH ACCIDENT $1,000,000
<br />E.L. DISEASE - EA EMPLOYEE $1,000,000
<br />(Mandatory In NH)
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E.L, DISEASE- POLICY LIMIT $1,000,000
<br />D
<br />Professional Liability
<br />AEC901463201
<br />5!112017
<br />5/112018
<br />Each Claim $5,000,000
<br />Aggregate $10,000,000
<br />DESCRIPTION OF OPERATIONS ! LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
<br />RE: CES Delphi Channel Diversion.
<br />Additional Insured coverage applies to General Liability and Automobile Liability for the City of Santa Ana, its officers, employees, agents,
<br />volunteers and representatives per policy form. Waiver of subrogation applies to General Liability, Automobile Liability, and Workers
<br />Compensation per policy form. Professional Liability - Claims made farm, defense costs included within limit. If the insurance company elects
<br />to cancel or non -renew coverage a 30 days written notico of such cancellation or nonrenewal will be ovided and 10 days for nonpayment of
<br />premium. (/L 15-_1 t H6C A04I -_ilkq
<br />CERTIFICATE HOLDER CANCELLATION 11 1 4 G
<br />ACORD 25 (2014101)
<br />001988-2014 ACORD CORPORATION. All rights reserved.
<br />The ACORD name and logo are registered marks of ACORD
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />City of Santa Ana
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />20 Civic Center Plaza
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />Santa Ana CA 92702
<br />AUTHORIZED REPRESENTATIVE
<br />ACORD 25 (2014101)
<br />001988-2014 ACORD CORPORATION. All rights reserved.
<br />The ACORD name and logo are registered marks of ACORD
<br />
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