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Client#: 2039770 HARRIASS5
<br />DATE (MM/DD/YYYY)
<br />ACORD.,,, CERTIFICATE OF LIABILITY INSURANCE 1 7/18/2024
<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 any rights to the certificate holder in lieu of such endorsement(s).
<br />PRODUCER I CONTACT Jarnb Wheeler
<br />NAME:
<br />USI Insurance Services, LLC
<br />Lic # OG11911
<br />10940 White Rock Rd 2nd FI
<br />Rancho Cordova, CA 95670
<br />INSURED
<br />Harris & Associates, Inc.
<br />1401 Willow Pass Rd lie 500
<br />Concord, CA 94520 A
<br />[K1111T/ 4:7_TO:61
<br />I �
<br />A/C, No, Ext :
<br />E-MAIL at ob.
<br />ADDRESS: _—
<br />INSURERA. V2 'Y
<br />INSURER B : C ant,
<br />INSURER C : merit
<br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW H 17 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 />INSR
<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 />X
<br />X
<br />6072176739
<br />8/01/2023
<br />08101/2024
<br />EACH OCCURRENCE
<br />$1,000,000
<br />CLAIMS -MADE L* OCCUR
<br />PREMISESOEa oceu ante
<br />$1,000,000
<br />X
<br />MED EXP (Any one person)
<br />$15,000
<br />Ded: 0
<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 ^I JECTPRO- X LOC
<br />PRODUCTS - COMP/OPAGG
<br />$2,000,000
<br />$
<br />OTHER:
<br />C
<br />AUTOMOBILE
<br />LIABILITY
<br />X
<br />X
<br />6076590520
<br />08/01/2023
<br />08/01/202
<br />COEaMBINED accidentSINGLE LIMIT
<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 />PROPERTY DAMAGE
<br />Per accident
<br />$
<br />HIRED NON -OWNED
<br />AUTOS ONLY AUTOS ONLY
<br />X
<br />$
<br />Ded: 0
<br />B
<br />UMBRELLA LIAB
<br />X
<br />OCCUR
<br />6076590551
<br />8/01/2023
<br />08/0112024
<br />EACH OCCURRENCE
<br />$1 O 00O 000
<br />X
<br />AGGREGATE
<br />$1 O 00O 000
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />DED I X RETENTION $10000
<br />$
<br />C
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY
<br />ANY PROPRIETOR/PARTNER/EXECUTIVE Y/ N
<br />OFFICER/MEMBER EXCLUDED? NI
<br />(Mandatory in NH)
<br />N / A
<br />X
<br />7034219554
<br />08/01/2023
<br />08/01/202
<br />X STATUTE PER OTH-
<br />ER
<br />E.L. EACH ACCIDENT
<br />$1,000,000
<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 />D
<br />Professional Liab
<br />X
<br />AEH591891588
<br />08/01/2023
<br />08/01/2024
<br />$5,000,000 Each Claim
<br />Claims -Made
<br />$10,000,000 Aggregate
<br />Ded: $500,000
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
<br />RE: On -call Engineering Plan Check Services. The City of Santa Ana, its City Council, its officers,
<br />officials, employees, and volunteers are listed as additional insureds on the General Liability and Auto
<br />Liability policies, on a primary and non-contributory basis, when required by written contract, per
<br />attached. Waiver of Subrogation applies to General Liability, Auto Liability, Workers Compensation, and
<br />Professional Liability policies, when required by written contract, per attached. Excess Follows form. 30
<br />Days notice of cancellation applies, per attached.
<br />CERTIFICATE HOLDER CANCELLATION
<br />1240002000 2029
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF
<br />City of Santa Ana
<br />ACCORDANCE WITH THE POLICY
<br />RAManagmumtDMslcrn
<br />20 Civic Center Plaza M-30
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<br />REVIEWED & PaPPROVm BY:
<br />P.O. Box 1988
<br />AUTHORIZED REPRESENTATIVE
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<br />r�z Aczt,44
<br />Santa Ana, CA 92702
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<br />Risk Management Specialist
<br />"'� © 8-2015 ACOR
<br />ACORD 25 (2016/03) 1 of 1 The ACORD name and logo are registered marks of ACORD
<br />#S45591163/M44908209
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