|
ACORO® CERTIFICATE OF LIABILITY INSURANCE
<br />GATE (MM/DD YYYV)
<br />12/4/2018
<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(les) 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 />this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
<br />PRODUCER
<br />Dealey, Renton & Associates
<br />790 E Colorado Blvd #460
<br />Pasadena, CA 91101
<br />CONTACT
<br />NAME: Marie Swaney
<br />PHONE FAX
<br />c e Ext h 626-844-3070 A/c No
<br />AADDRESS: mswane deale renton.com
<br />INSURERS AFFORDING COVERAGE NAIC#
<br />Lic#0020739
<br />INSURER A: Travelers Property Casualty Cc of Amen 25674
<br />680511299911
<br />INSURED JOHNEKAL11
<br />John Kaliski Architects dba John Kaliski Arch.
<br />3780 Wilshire Blvd., Suite 300
<br />INSURER B: Travelers Indemnity Co. of Connecticut 25682
<br />INSURERc: Aspen American Insurance Company
<br />NsuRERD:
<br />Los Angeles, CA 90010
<br />INSURER E:
<br />213 383-7980
<br />INSURER F:
<br />COVERAGES CERTIFICATE NUMBER: 573149273 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 />ADDLSUBR
<br />INSD
<br />MD
<br />POLICYNUMBER
<br />POLICY EFF
<br />IMMlDDfYYYYI
<br />POLICY EXP
<br />(MillLIMITS
<br />A
<br />X COMMERCIAL GENERAL LIABILITY
<br />Y
<br />Y
<br />680511299911
<br />12/13/2018
<br />12/13/2019
<br />EACH OCCURRENCE $2,000,000
<br />CLAIMS -MADE I OCCUR
<br />PREMISES Ea occurrence) $ 2,000,000
<br />MED EXP (Any one person) $10,000
<br />X Contactual List,
<br />X XCU Included
<br />PERSONAL S ADV INJURY $2,000,000
<br />GENT AGGREGATE LIMIT APPLIES PER:
<br />GENERAL AGGREGATE $4,000,000
<br />POLICY [X ] JE'CT F LOC
<br />PRODUCTS-COMP/OP AGG $4,000,000
<br />S
<br />OTHER:
<br />B
<br />AUTOMOBILE LIABILITY
<br />Y
<br />Y
<br />BA670BL755
<br />12/13/2018
<br />12/13/2019
<br />COMBINED SINGLE LIMIT $1,000,000
<br />Ee accident
<br />BODILY INJURY (Per person) $
<br />ANY AUTO
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />BODILY INJURY (Per accident) $
<br />PROPERTY DAMAGE $
<br />Per accident
<br />X HIRED X NON -OWNED
<br />AUTOS ONLY AUTOS ONLY
<br />$
<br />X NoOwmdAutos
<br />UMBRELLA LIAB
<br />OCCUR
<br />EACH OCCURRENCE $
<br />AGGREGATE $
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />DED I I RETENTION$
<br />$
<br />A
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY YIN
<br />Y
<br />UBBM739089
<br />12/13/2018
<br />12/13/2019
<br />X I PER 10H-
<br />STATUTE ER
<br />ANYPROPRIETORIPARTNERIEXECUTIVE
<br />E.L. EACH ACCIDENT $1,000,000
<br />OFFICER/MEMBER EXCLUDED? ❑
<br />NIA
<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 />C
<br />Professional Liability
<br />AAAE10026000
<br />12/13/2016
<br />12/13/2019
<br />$1,000,000 Per Claim
<br />$2,000,000 Annl Aggregate
<br />DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
<br />Insured awns no company vehicles; therefore, hired/non-owned auto is the maximum coverage that applies.
<br />Re: On-call services, 0210 141125 — City of Santa Ana, its officers, employees, agents,volunteers and representatives are named as additional insured as
<br />respects general & auto liability for claims arising from the operations of the named insured as required per written contract or agreement. General Liability is
<br />Primary/Nan-Contributory per policy form wording. insurance coverage includes waiver of subrogation per the attached endorsement(s).
<br />City of Santa Ana
<br />Attn: Exec. Dir of PBA
<br />PO BOX 1988
<br />Santa Ana CA 92702
<br />ACORD 25 (2016/03)
<br />I r P1CFP1rr�ePNrfl=1
<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 />AUTHORIZED REPRESENTATIVE
<br />;o714F:f:bI17, 6y_[HU:7 k]
<br />The ACORD name and logo are registered marks of ACORD
<br />All riahts reserved.
<br />
|