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<br />1 ®
<br />A` ORO CERTIFICATE OF LIABILITY INSURANCE
<br />DATE(MMIDDIYVYY)
<br />D5I24aD1B
<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(los) must have ADDITIONAL INSURED provisions or be endorsed. If
<br />SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this
<br />certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
<br />PRODUCER
<br />Aon Risk Insurance Services west, Inc.
<br />Los Angeles CA Office
<br />707 Wilshire Boulevard
<br />Suite 2600
<br />CONTACT
<br />NAME'
<br />INC. No. Exp: (866) 283-7122 FAX
<br />No.): 600) 363-0105
<br />E-MAIL
<br />ADDRESS:
<br />INSURER(S) AFFORDING COVERAGE NAIC#
<br />Les Angeles CA 90017-0460 USA
<br />INSURED
<br />INSURERA: Travelers Property Cas CO of America 25674
<br />Newcomb, Anderson, McCormick. Inc.,
<br />201 Mission Street, Suite 2000
<br />INSURER B: Lexington Insurance Company 19437
<br />INSURERC:
<br />San Francisco CA 94150 USA
<br />NSURER D:
<br />NSURER E:
<br />INSURER F:
<br />COVERAGES CERTIFICATE NUMBER: 570071360444 REVISION NUMBER:
<br />THIS IS TO CERTIFY THATTHE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMEDABOVE 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 />EXCLUSIONSAND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. Limits shown are as requested
<br />INSR
<br />LTR
<br />TYPE OF INSURANCE
<br />INSD
<br />BIR
<br />MD
<br />POLICYNUMBER
<br />P.U11 Ell
<br />id MID
<br />UU1 EXP
<br />MM
<br />LIMITS
<br />A
<br />X COMMERCIAL GENERAL LIABILITY
<br />Y
<br />Y
<br />P63073366586TIL11
<br />11/UU/ZU11
<br />11/U9/ZU1K
<br />EACH OCCURRENCE $1,000,000
<br />CLAIMS -MADE X❑ OCCUR
<br />DAMAGE—TO RE TED $1,000,000
<br />PREMISES Ea occurrence
<br />MED EXP (Any one person) $15,000
<br />X Employee Benefits Liability
<br />X I Contractual Liability Included
<br />PERSONAL B ADV INJURY $1,000,000
<br />GEN'LAGGREGATE LIMITAPPLIES PER:
<br />GENERALAGGREGATE $2,000,000
<br />X POLICY ❑PEO, LOC
<br />PRODUCTS - COMPIOP AGG $2,000,000
<br />OTHER:
<br />A
<br />AUTOMOBILE LIABIUTY
<br />Y
<br />Y
<br />P -810 -73365332 -TIL -17
<br />11/09/201711/09/2018
<br />COMBINED SINGLE LIMIT $1,000,000
<br />Ea accident
<br />BODILY INJURY( Per person)
<br />X ANYAUTO
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />HIRED Oros NON -OWNED
<br />ONLY AUTOS ONLY
<br />BODILY INJURY (Per accident)
<br />PROPERTY DAMAGE
<br />Peraccmenn
<br />A
<br />X
<br />UMBRELLALIAB X OCCUR
<br />CUP935811041743
<br />11/09/2017
<br />11/09/2018
<br />EACH OCCURRENCE $$,000,000
<br />EXCESS LIAB CLAINI"ADE
<br />AGGREGATE $5,000,000
<br />DED RETENTION
<br />A
<br />WORKERS COMPENSATION AND
<br />EMPLOVERS'LIABILITY YIN
<br />ANY PROPRIETOR I PARTNER I EXECUTIVE
<br />OFFICEIMEMBER EXCLUDED? N
<br />(Mandatory in NH)
<br />NIA
<br />Y
<br />PJUB9355881917
<br />11/09/2017
<br />11/09/2018
<br />X I PER STATUTE OTH-
<br />ER
<br />E.L EACH ACCIDENT $1,000,1)06
<br />E.L. DISEASE -EA EMPLOYEE $1,000,000
<br />Ryas, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />I
<br />I
<br />E.L. DISEASE -POLICY LIMIT $1,000,000
<br />B
<br />Archit&Eng Prof
<br />02817491211/09/2017
<br />11/09/2018
<br />Aggregate $2,000,000
<br />SIR applies per policy ter
<br />s & condi
<br />ions
<br />Per claim $1,000,000
<br />SIR $250,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
<br />RE: All Operations for work performed by the Named Insured as required by written contract.
<br />City of Santa Ana is included as Additional Insured in accordance with the policy provisions of the General Liability and
<br />Automobile Liability policies. General Liability and Automobile Liability evidenced herein is Primary and Non -Contributory to
<br />other insurance available to an Additional Insured, but only in accordance with the policy's provisions. A waiver of
<br />Subrogation is granted in favor of certificate Holder in accordance with the policy provisions of the General Liability,
<br />Automobile Liability, and workers' Compensation policies.
<br />J
<br />I/
<br />CERTIFICATE HOLDER CANCELLATION Ln
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
<br />EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE
<br />POLICY PROVISIONS.
<br />City Of Santa Ana AUTHORIZED REPRESENTATIVE
<br />20 civic Center Plaza (M-30)
<br />Santa Ana CA 92702-1988 USA oJG/`
<br />exon ✓L�frJ�iMdifauas �sbsaora fYcdCJ0ivru
<br />©1988-2015 ACORD CORPORATION. All rriiigghtts' reserved.
<br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD I V
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