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ACCORDCERTIFICATE OF LIABILITY INSURANCE �� DATE(M4//0192019 Y) 05/1° THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT. If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Customer Service Department NAME: Target Insurance Services ACNE Ext : (800) 450-8013 FAX No): (866) 227-3052 E-MAIL Certificates@premieragencyservices.com ADDRESS: 6630 Flanders Drive INSURER(S) AFFORDING COVERAGE NAIC # San Diego CA 92121 INSURERA: Underwriters at Lloyd's London N/A INSURED INSURER B : United Financial Casualty Co 11770 Forness Construction Inc INSURER C : State Compensation Ins Fund of CA 35076 1965 N. Beale Road INSURER D : INSURER E Marysville CA 95901 INSURER F COVERAGES CERTIFICATE NUMBER: PP/XS 19-20 & WC/BA 18- REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW'HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDLSUBR INSD WVD POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE X OCCUR DAMAGE TO RENTED PREMISES Ea occurrence 100,000 $ MED EXP (Any one person) $ 25,000 PERSONAL &ADV INJURY $ 1,000,000 A Y ENC000340901 05/03/2019 05/03/2020 GEN'LAGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY � PRO- ❑ LOC JECT PRODUCTS -COMP/OPAGG $ 2,000,000 $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ 1,000,000 BODILY INJURY (Per person) $ X ANY AUTO B OWNED SCHEDULED AUTOS ONLY AUTOS 01931135-6 11/06/2018 11/06/2019 BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY Uninsured/Underinsured $ 1,000,000 UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,000 X AGGREGATE $ 1,000,000 A EXCESS LIAB CLAIMS -MADE ENX000026001 05/03/2019 05/03/2020 DED I I RETENTION $ $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) N /A 9149967-18 12/30/2018 12/30/2019 SPER TATUTE EORH X1 E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT 1,000,000 $ A Pollution Liability Bailes EVC000340901 05/03/2019 05/03/2020 Agg./Each POL Claim Occurrence $2M/$1 M $250,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) The City of Santa Ana, it's officers, employees, agents and representatives are named as Additional Insured; Primary Non-Contibutory Wording applies, per the attached Endorsement(s). Certificate Holder Reference: On -Call Agreements A-2017-220 *Additional Insured status is subject to all policy terms, exclusions and conditions* CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN The City of Santa Ana Public Works Agency ACCORDANCE WITH THE POLICY PROVISIONS. 20 Civic Center Plaza, M-36 AUTHORIZED REPRESENTATIVE Santa Ana CA 92701 D ©1988-2016 ACORD CORPORATION. All rights reserved. ACORD 26 (2016/03) The ACORD name and logo are registered marks of ACORD