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<br />, ,u„.n..� ,,. t u�u, �u� WR3NI.OSZ113i935 LTN'
<br />NICHCON-02 M G WM
<br />'A`� CERTIFICATE OF LIABILITY INSURANCE EV
<br />DATE(M1202Y Y)
<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, sub"i" 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 # OES7768
<br />IDA Insurance Services
<br />4370 La Jolla Village Drive
<br />Suite 600
<br />San Diego, CA 92122
<br />E& LAcT Erlea Wilson
<br />PHONE
<br />(AID, No, Ell): (858) 754-0063 50233 jA c, No):(619) 574$28ti
<br />hss. Erica.Wilson@loausa.com
<br />INSURERS AFFORDING COVERAGE
<br />NAIC9
<br />INSURER A: RLI Insurance Company
<br />13056
<br />INSURED
<br />INSURER B: Interstate Fire & CaSUaItY COm an f
<br />22829
<br />INSURERC:
<br />Nichols Consulting Engineers, CHTD
<br />1885 S. Arlington Ave., #111
<br />Reno, NV 89609
<br />INSURER D:
<br />INSURER E:
<br />INSURER F:
<br />COVERAGES CFRTIFICATF NIIMRFR• mc9nrs+nu wum �+..
<br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
<br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />ILTR NSR
<br />TYPE OF INSURANCE
<br />ADDL
<br />BUBR
<br />ppLICY NUMBER
<br />05LICYEFF
<br />POLICY EXP
<br />LIMBS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />$ 1,000,000
<br />CLAIMsMADE [X] OCCUR
<br />X
<br />PSBOOD3222
<br />6/17/2021
<br />6/17/2022
<br />pEDACHOCCURRENCE
<br />PREMTa18ES R
<br />S 1,000,000
<br />Cont Llah/Sev of Int
<br />u�o ce
<br />MED EXP fAny oneperson)
<br />X
<br />$ 10,000
<br />PERSONAL a ADV INJURY
<br />5 1,000,000
<br />GEN'L
<br />AGGREGATE LIMIT APPLIES PER:
<br />POLICY j
<br />GENERAL AGGREGATE
<br />E 2,000,000
<br />PRODUCTS-COMPA)PAGO
<br />§ 2,000,000
<br />LOC
<br />Deductible
<br />0
<br />OTHER'
<br />A
<br />AUTOMOBILE
<br />LIABILITY
<br />rBBIINEDSINGLELIMIT
<br />n
<br />E 1,000,000
<br />BODILY INJURY x rson
<br />E
<br />ANY AUTO
<br />X
<br />PSA0001184
<br />5117/2021
<br />5/17/2022
<br />Ix
<br />BODILY BOOpDILY INJURY Per accident
<br />$
<br />OWNED SCHEDULED
<br />A�UgT118 ONLY AUTOS
<br />PPera�dan AMAGE
<br />$
<br />AUTOS ONLY AUTO�ONLV
<br />ComP.:$500 X Coll.:$500
<br />A
<br />UMBRELLA LIAR X OCCUR
<br />EACH OCCURRENCE
<br />S
<br />s 5,000,000
<br />X
<br />5/17/2022
<br />AGGREGATE
<br />$ 5,000,000
<br />EXCESSLM.B CLAIMS -MADE
<br />PSE0003030
<br />5/17/2021
<br />DED X RETENTIONS 0
<br />$
<br />A
<br />ANDELELBITMPOYRSIALIIY
<br />X 9TA ERH
<br />ANY PROPREIEfgO�Ry/PARTNERADfECUTIVE YIN
<br />X
<br />PSW0001855
<br />5/17/2021
<br />5/17/2022
<br />E
<br />E.L EACH ACCIDENT
<br />§ 1,000,000
<br />(MandetorydescnlnN )EXCLUDED4
<br />(Myyeess��
<br />MIA
<br />E.L DISEASE -EA EMPLOYE
<br />E 1,000,000
<br />ander
<br />EL DISEASE- POLICY LIMIT
<br />$ 1,000,000
<br />DESCR IO I OF OPERATIONS below
<br />B
<br />Professional Liab.
<br />USF00807821
<br />5/17@021
<br />6/17/2022
<br />Per Claim
<br />5,000,000
<br />B
<br />Ded.: $50k Per Claim
<br />USFOO807821
<br />6111,2021
<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, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />City of Santa Ana AUTHORIZED REPRESENTATIVE
<br />Risk Management DivisionT ✓ ,rt„gyp ai )�Dna�
<br />20 Civic Center Plaza oIl
<br />y' rav EwED s APPROV®8V
<br />Santa Ana. CA 92702
<br />ACORD 25 (2016103) ©1988-2015 ACORD C
<br />The ACORD name and logo are registered marks of ACORD �� Rak Management Analyst
<br />
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