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Digitally signed by Francine R.
<br />Francine R. Villareal Villareal
<br />Date: 2021.05.20 123455-07'00'
<br />NICHCON-02 MCGRAWM
<br />CERTIFICATE OF LIABILITY INSURANCE
<br />DATE (MM/DD/YYYY)
<br />5/14/2021
<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(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 />this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
<br />PRODUCER License # OE67768
<br />CONTACT Erica Wilson
<br />NAME:
<br />PHONE FAX
<br />(A/C, No, Ext): (858) 754-0063 50233 (A/c, No): (619) 574-6288
<br />IDA Insurance Services
<br />4370 La Jolla Village Drive
<br />Suite 600
<br />E-MAILErica.Wilson@ioausa.com
<br />San Diego, CA 92122
<br />INSURER S AFFORDING COVERAGE
<br />NAIC #
<br />INSURERA: RLI Insurance Company
<br />13056
<br />INSURED
<br />INSURER B: Interstate Fire & Casualty Company
<br />22829
<br />INSURER C 7
<br />Nichols Consulting Engineers, CHTD
<br />INSURER D :
<br />1886 S. Arlington Ave., #111
<br />Reno, NV 89609
<br />INSURER E
<br />INSURER F :
<br />COVERAGES CERTIFICATE NUMBER: 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 CONTRACTOR 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 />ADDL
<br />INSD
<br />SUBR
<br />WVD
<br />POLICY NUMBER
<br />POLICY EFF
<br />MM/DD/YYYY
<br />POLICY EXP
<br />MM/DD/YYYY
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />CLAIMS -MADE X OCCUR
<br />X
<br />PSB0003222
<br />5/17/2021
<br />5/17/2022
<br />DAMAGE TO RENTED
<br />PREMISES Ea occurrence
<br />1 000 000
<br />$
<br />X
<br />MED EXP (Any oneperson)
<br />$ 10,000
<br />Cont Liab/Sev of Int
<br />PERSONAL & ADV INJURY
<br />$ 1,000,000
<br />GEN'L
<br />AGGREGATE LIMIT APPLIES PER:
<br />GENERAL AGGREGATE
<br />$ 2,000,000
<br />POLICY L ^I JECT El LOC
<br />PRODUCTS - COMP/OP AGG
<br />$ 2,000,000
<br />Deductible
<br />$ 0
<br />OTHER:
<br />A
<br />AUTOMOBILE
<br />LIABILITY
<br />COMBINED SINGLE LIMIT
<br />Ea accident
<br />1,000,000
<br />$
<br />X
<br />BODILY INJURY Perperson)
<br />$
<br />ANY AUTO
<br />X
<br />PSA0001184
<br />6/17/2021
<br />6/17/2022
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />BODILY INJURY Per accident
<br />$
<br />PROPERTY DAMAGE
<br />Per accident
<br />$
<br />HIRED NON -OWNED
<br />AUTOS ONLY AUTOS ONLY
<br />X
<br />Comp.: $500 X Coll.: $500
<br />A
<br />UMBRELLA LIAB
<br />X
<br />OCCUR
<br />EACH OCCURRENCE
<br />$ 5,000,000
<br />X
<br />EXCESS LAB
<br />CLAIMS -MADE
<br />PSE0003030
<br />6/17/2021
<br />6/17/2022
<br />AGGREGATE
<br />$ 5,000,000
<br />DED X RETENTION $ 0
<br />$
<br />A
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY
<br />YIN
<br />ANY PROPRIETOR/PARTNER/EXECUTIVE ❑
<br />OFFICER/MEMBER EXCLUDED?
<br />(Mandatory in NH)
<br />N /A
<br />X
<br />PSW0001955
<br />5/17/2021
<br />5/17/2022
<br />X PER OTH-
<br />STATUTE ER
<br />E.L. EACH ACCIDENT
<br />1,000,000
<br />$
<br />E.L. DISEASE- EA EMPLOYEE
<br />$ 1,000,000
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE - POLICY LIMIT
<br />1,000,000
<br />$
<br />B
<br />Professional Liab.
<br />USF00807821
<br />6/17/2021
<br />6/17/2022
<br />Per Claim
<br />5,000,000
<br />B
<br />Ded.: $50k Per Claim
<br />USF00807821
<br />6/17/2021
<br />6/17/2022
<br />Aggregate
<br />5,000,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
<br />Re: All Operations
<br />City of Santa Ana, its officers, employees, agents and representatives are Additional Insureds with respect to General and Auto Liability per the attached
<br />endorsements as required by written contract. Insurance is Primary and Non -Contributory. Waiver of Subrogation applies to Workers' Compensation.
<br />30 Days Notice of Cancellation with 10 Days Notice for Non -Payment of Premium in accordance with the policy provisions.
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF,
<br />NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />City of Santa Ana
<br />AUTHORIZED REPRESENTATIVE
<br />Risk Management Division
<br />—7� �[ /
<br />e
<br />RiskMwagmerdDMsian
<br />20 Civic Center Plaza
<br />REVIEWED & APPROVED BY. -
<br />Santa Ana CA 92702
<br />0
<br />V; cyst
<br />ACORD 25 2016/03
<br />©1988-2015 ACORD C
<br />The ACORD name and logo are registered marks of ACORD
<br />`—1
<br />RisknnanagementAnalyst
<br />
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