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<br />i-� RINCCON-01 PRIET P
<br />ACORO' CERTIFICATE OF LIABILITY ATE INSURANCE O01/28/2 Yol9
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<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 BYTHEPOLICIES
<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 />PRODUCER 11•.rrao m vuv, r vu
<br />Legends Environmental Ins. Services
<br />130 Vantis
<br />Suite 250
<br />Aliso Viejo, CA 92656
<br />52011 INC.Np14949)297-5960
<br />INSURER A: Crum & Forster Specialty Insurance Company_
<br />INSURED INSURER B: Trumbull Insurance Company
<br />Rincon Consultants, Inc. _ INSURER C: StarStone. National Insurance Company
<br />210 N Ashwood Ave INSURER D:
<br />Ventura, CA 93033
<br />INSURER E
<br />rn\/CD ecce rCOTICIr ATC MIIMIOCC. oevlernki Mnueee.
<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
<br />WHICH THIS
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL
<br />THE TERMS,
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />__-
<br />INSR TYPE OFINSURANCE ADOL SUER POLICY NUMBER POLICYEFF MPOLICY
<br />LTRA MIDD1EXP LIMITS
<br />X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $
<br />3'000'006
<br />CLAIMS -MADE X OCCUREPK125280 1211712018 12/17/2020 DAMAGE TO RENTED
<br />X PREMISES IF. occurtercg�._$_
<br />5g�pgg
<br />10'000
<br />MED EXP (Am one person)_ _ $
<br />PERSONAL& ADV INJURY S___3,_000_1001
<br />GEN'L AGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE $
<br />4'000,000
<br />POLICY X JECT LOC PRODUCTS-COMPIOPAGG $
<br />4,000,000
<br />50,000
<br />OTHER: .Deductible $
<br />B AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
<br />(Ea accident) $
<br />1,000,000
<br />X ANY AUTO X 72UUNPT4318 12/17/2018 12/17/2019 BODILY INJURY (Par parson) $
<br />OWNED SCHEDULED
<br />_ _AUTOS ONLY AUTOS BODILY INJURY (Per accident) $
<br />RldantDAMAGE
<br />XHRXOpWO
<br />AUTOLB
<br />. TOS ONLY PeOa $
<br />8
<br />A UMBRELLA LMB X OCCUR EACH OCCURRENCE $
<br />5'000'000
<br />X EXCESS LIAR CLAIMSMADEEFX111982 1211712018 12/17/2019 AGGREGATE_. _$
<br />5'000.000
<br />DED X RETENTION$ 10,000
<br />C WORKERS COMPENSATION X PER OTH-
<br />STATUTE ER
<br />AND EMPLOYERS' LIABILITY YIN--
<br />710190329 02101/2019 02/01/2020
<br />1,000,000
<br />ANY PROPREIET�O�Rq/PARTNER/EXECUTIVE N NIA E.L. EACH ACCIDENT $
<br />EXCLUDED?
<br />_
<br />Ma IC' in NH)
<br />rY
<br />1,000,000
<br />( E.L. DISEASE - EA EMPLOYEE $
<br />If yes, describe under
<br />1,000,000
<br />DESCRIPTION OF OPERATIONS below - E.L. DISEASE -POLICY LIMIT $
<br />A Professional Liab EPK125280 12/1712018 12/17/2020 Per Claim
<br />3,000,000
<br />A Professional Liab EPK125280 12/17/2018 12/17/2020 Aggregate
<br />4,000,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
<br />Re: Agreement N-2018.060
<br />`Professional Liability is written on a Claims Made basis. When required by written contract, the General Liability and Pollution Liability Limits are on a Per
<br />Project basis while dedicated; the Professional Liability is on a Per Policy basis. Professional Liability Deductible $50,000 Each Claim.
<br />The City of Santa Ana its officers, employees, agents, volunteers and representatives are included as additional insureds for General Liability and Auto
<br />Liability with respect to work performed for them by the Named Insured as required by written contract, per Blanket Additional Insured endorsement EN0147-
<br />1111, EN0320-0211, EN0321-0211 & HA99160312. Liability Coverage is Primary and Non -Contributory as required by written contract, per endorsement EN0147
<br />SEE ATTACHED ACORD 101
<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 />City of Santa Ana - Public Works Agency AUTHORIZED REPRE r EWED e
<br />Attn: Water Resources Department �L t /�
<br />20 Civic Center Plaza, M-21, P.O. Box 1988 /(jIU�M-6*4
<br />Santa Ana, CA 92ZO2
<br />ACORD 25 (2016/03) ©-7a,01�.ACORO COR ION.�All rights reserved.
<br />The ACORD name and logo are registered mars 11C�� a '�'
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