ACORD®
CERTIFICATE OF LIABILITY INSURANCE
DATE (MM/DD/YYYY)
08/31/2023
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).
CONTACT Certificate Department
NAME:
PHONE (410) 832-7600
A/C No. Extl:
-MAIL [email protected]
ADDRESS:
PRODUCER
Klein Agency, LLC
P.O. Box 219
Timonium MD 21094
INSURED
Infrastructure Engineers, a Bowman Company
3060 Saturn Street
Suite 250
Brea
CA 92821
(A/CFAx, No): () 410 832-1849
INSURER(S) AFFORDING COVERAGE
INSURERA: Charter Oak Fire Insurance Co
INSURER B : Travelers Indemnity Co. of Am
INSURER C : Travelers Property Casualty Co. of America
INSURER D : Berkshire Hathaway Specialty Insurance
INSURER E : Beazley Insurance Company
INSURER F :
COVERAGES CERTIFICATE NUMBER: 23-24 Infrastructure Eng. 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 ADDL SUER POLICY EFF POLICY EXP
TYPE OF INSURANCE
LTR INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY)
X COMMERCIAL GENERAL LIABILITY
A
B
CLAIMS -MADE X OCCUR
X Contractual Liability
GEN'L AGGREGATE LIMIT APPLIES PER:
PRO-
JECT
POLICY
X
OTHER:
AUTOMOBILE LIABILITY
X - ANY AUTO
- OWNED
AUTOS ONLY
HIRED
AUTOS ONLY
X UMBRELLA LIAR
C EXCESS LIAB
DED 1 1 RETENTION $
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE
C OFFICER/MEMBER EXCLUDED?
(Mandatory in NH)
If yes, describe under
DESCRIPTION OF OPERATIONS below
LOC
SCHEDULED
AUTOS
NON -OWNED
AUTOS ONLY
X
OCCUR
CLAIMS -MADE
Y/N
N
Primary Professional & Pollution Liab /
D/E Excess Professional & Pollution Liab
6306J047645 08/31/2023 08/31/2024
8108T020319
CUP6J395074
N/A UB6J317115
47-EPP-330666-01
LIMITS
EACH OCCURRENCE
DAMAGE TO RENTED
PREMISES (Ea occurrence)
MED EXP (Any one person)
PERSONAL &ADV INJURY
GENERAL AGGREGATE
PRODUCTS - COMP/OP AGG
COMBINED SINGLE LIMIT
(Ea accident)
BODILY INJURY (Per person)
08/31/2023 08/31/2024 BODILY INJURY (Per accident)
PROPERTY DAMAGE
(Per accident)
08/31/2023 08/31/2024
08/31/2023 08/31/2024
EACH OCCURRENCE
AGGREGATE
XI STATUTE
E.L. EACH ACCIDENT
OTH-
ER
E.L. DISEASE - EA EMPLOYEE
E.L. DISEASE - POLICY LIMIT
Each Claim/Aggregate
NAIC #
25615
25666
25674
22276
37540
1,000,000
1,000,000
10,000
1,000,000
2,000,000
2,000,000
1,000,000
25,000,000
25,000,000
$ 1,000,000
$ 1,000,000
$ 1,000,000
$5,000,000
08/31/2023 08/31/2024 Excess Each Claim/Aggr. $5,000,000 DESCRIPTION OF OPERATIONS/ LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Re: All operations. Endorsements CGD414, CGF475, CAF227, CAF129, WC000313 are attached. If required by an insured written contract, executed prior to any loss, The City of Placentia and its elected and appointed boards, officers, officials, agents, employees, and volunteers are an Additional Insured on a primary and non-contributory basis under the General and Auto Liability Policies. If required by an insured written contract, executed prior to any loss, Waiver of Subrogation is provided for General, Auto, and Workers Compensation Policies. Umbrella Policy follows form over General, Auto, and Employer's Liability Policies. 30 day notice of cancellation, 10 day for non-payment.
CERTIFICATE HOLDER CANCELLATION
City of Placentia
401 E. Chapman
Placentia
CA 92870
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
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