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ACCA?6r CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY)
<br />6..� 1 10/20/2023
<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 CONTACT
<br />NAME: Jo Lusk
<br />AssuredPartners Design Professionals Insurance Services, LLC PHONE FAX
<br />272-1465
<br />3697 Mt. Diablo Blvd Suite 230 E M No EXt (A/C, No :
<br />Lafayette CA 94549 /�DEs i s c
<br />_ V 1 1 IALSILREN(3j A OROIJf 8JEIkAIll %A NAIC #
<br />AnniiPLicense#- 6003745 usURERA: BERKLEY INSU ANCE COMPANY 32603
<br />INSURED MIGINCO-01 vs ra e r y sU 25674
<br />MIG, Inc.
<br />Moore lacofano Goltsman, Inc. IN Th T e it C o 25682
<br />800 Hearst Ave INsL IERD: The Travelers Indemnity Company 25658
<br />Berkeley CA 94710 INS E, A Agn
<br />ate
<br />KtRF:
<br />COVERAGES Ama E cNAAAMTE40A8951 REVISION -NUMBER:
<br />THIS IS TO CERTIFY HAT C IN A T BE N C D f1 NS E�, A O R THE POLICY PERIOD
<br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM f �t )NDITIO OF A N DO T SPECT TO WHICH THIS
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSU',ff -E AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHGvJN 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
<br />POLICY EXP
<br />MM/DD
<br />LIMITS
<br />C
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />Y
<br />Y
<br />6801H899998
<br />8/31/2023
<br />8/31/2024
<br />EACH OCCURRENCE
<br />$1,000,000
<br />CLAIMS -MADE FxIOCCUR
<br />PREMIDAMAETORENTED
<br />PREMISES Ea occurrence
<br />$ 1,000,000
<br />X
<br />MED EXP (Any one person)
<br />$ 10,000
<br />Contractual Liab
<br />Included
<br />PERSONAL &ADV INJURY
<br />$ 1,000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />GENERAL AGGREGATE
<br />$ 2,000,000
<br />POLICY jE LOC
<br />PRODUCTS - COMP/OP AGG
<br />$ 2,000,000
<br />$
<br />OTHER:
<br />C
<br />AUTOMOBILE
<br />LIABILITY
<br />Y
<br />Y
<br />BAOS579947
<br />8/31/2023
<br />8/31/2024
<br />COMBINED SINGLE LIMIT
<br />Ea accident
<br />$ 1,000,000
<br />X
<br />BODILY INJURY (Per person)
<br />$
<br />ANY AUTO
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />BODILY INJURY (Per accident)
<br />$
<br />X
<br />PROPERTY DAMAGE
<br />Per accident
<br />$
<br />NON -OWNED
<br />HIRED Ix
<br />AUTOS ONLY AUTOS ONLY
<br />B
<br />X
<br />UMBRELLALIAB
<br />X
<br />OCCUR
<br />Y
<br />Y
<br />CUPOH758762
<br />8/31/2023
<br />8/31/2024
<br />EACH OCCURRENCE
<br />$ 10,000,000
<br />AGGREGATE
<br />$ 10,000,000
<br />EXCESS LAB
<br />CLAIMS -MADE
<br />DED X RETENTION $ n
<br />$
<br />D
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY Y / N
<br />ANYPROPRIETOR/PARTNER/EXECUTIVE
<br />Y
<br />U1321-553909
<br />8/31/2023
<br />8/31/2024
<br />X I PER OTH-
<br />STATUTE ER
<br />E.L. EACH ACCIDENT
<br />$ 1,000,000
<br />OFFICER/MEMBER EXCLUDED?
<br />N /A
<br />E.L. DISEASE - EA EMPLOYEE
<br />$ 1,000,000
<br />(Mandatory in NH)
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE - POLICY LIMIT
<br />$ 1,000,000
<br />A
<br />Professional Liability&
<br />AEC907002005
<br />8/31/2023
<br />8/31/2024
<br />Per Claim/5,000,000
<br />$5,000,000/Aggr
<br />Contr. Pollution Liab Included
<br />Included
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required)
<br />Umbrella Liability policy is a follow -form to its underlying Policies: General Liability/Auto Liability/Employers Liability.
<br />RFP No #23-010. Project: California Environmental Quality Act (CEQA).
<br />City of Santa Ana, its officers, officials, employees, and volunteers are named as an additional insured as respects general liability and auto liability as required
<br />per written contract. General Liability is Primary/Non-Contributory per policy form wording. Insurance coverage includes waiver of subrogation per the attached
<br />endorsement(s).
<br />CERTIFICATE HOLDER CANCELLATION 30 Day Notice of Cancellation
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF. NOTICE WILL BE DELIVERED IN
<br />City of Santa Ana ACCORDANCE WITH THE POLICY PRC
<br />20 Civic Center Plaza (M-30) RAManagmumtDMsian
<br />P.O. Box 1988 AUTHORI D REPRESENTATIVE ' REVIEWED & APPROVED BY:
<br />Santa Ana CA 92702-1988
<br />Risk Management Specialist
<br />© 1988-2015 ACORD
<br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
<br />
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