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AC(:>RIYCERTIFICATE OF LIABILITY INSURANCE 711DATE 4!20 14/20 4 Y Y) <br />14 <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 a endorsed. I S OGATION IS WAIVED, subject to <br />the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the <br />certificate holder in lieu of such endorsement(s). rITY n;71 <br />PRODUCER SANIA 4N4 <br />M <br />Sealey, Renton 8 Associates PHNAo t.11 • - � FAx <br />D. O. BOX 10550 E-MAIA7C : <br />No <br />Santa Ana CA 92711-0550 ADOREL S <br />INSURED <br />PENCO Engineering, Inc. <br />16842 Von Karmen Avenue, Suite 150 <br />Irvine CA 92606 <br />COVERAGES CERTIFICATE NUMBER: .971`3621119 REVISION NUMRFR- <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 />NSR <br />LTR <br />TYPE OF INSURANCE <br />A <br />IN R <br />MD <br />POLICY <br />POLICYNUMBER MMIDIOIYYYY MMIDD/YYYY <br />LIMITS <br />A GENERAL LIABILITY <br />080876923 /2112014 /21/2015 EACH OCCURRENCE $1,000,000 <br />X COMMERCIAL GENERAL LIABILITY <br />AIAGI TO ED <br />PREMISES Ea occunrenca $1,000,000 <br />CLAIMS C OCCUR <br />-MADE <br />MED EXP (Any one person) $10,000 <br />'x Contractual <br />PERSONAL B ADV INJURY $1,000,000 <br />X BFPD, XCU <br />GENERAL AGGREGATE $2,000.000 <br />GEN'L AGGREGATE LIMIT APPLIES PER. <br />PRODUCTS - COMP/OP AGG$2,000,000 <br />POLICY X PRO- LOC <br />$ <br />D <br />AUTOMOBILE LIABILITY <br />MZA80306282 <br />/2112014772112015 Ea accident $1,000,000 <br />x ANY AUTO <br />T® FORM BODILY INJURY (Par parson) $ <br />ALL OS SCHEDULED <br />As <br />AUTOS AUTOS <br />sarr�� O <br />BODILY INJURY (Per accident) $ <br />X X NON -OWNED <br />HIRED AUTOS AUTOS <br />App <br />1 <br />PROPERTVOAMAGE $ <br />Per acntlent <br />UMBRELLA LIAB <br />OCCUR <br />n$ <br />LiJ <br />rne� EACH OCCURRENCE $ <br />E XCESS LIAB <br />CLAIMS -MADE <br />^S <br />City Att <br />slStan!t <br />AGGREGATE $ <br />DED RETENTIONS <br />$ <br />C <br />WORKERS COMPENSATION <br />72WEGDZ3753 <br />/21/2014 7/21/2615 X WC $TATO- OTH- <br />AND EMPLOYERS' LIABILITY Y/N <br />ANY PROPRIETORIPARTNER'EXECUTIVE <br />E.L. EACH ACCIDENT $1,000,000 <br />OFFICERIMEMBER EXCLUDED? ❑ <br />NIA <br />(Mandatory in NMI <br />E.L DISEASE - EA EMPLOYEE $1,000,000 <br />If yea, describe under <br />DESCRIPTION OF OPERATIONS held. <br />E.L. DISEASE - POLICY LIMIT $1,000,000 <br />B <br />Professional Liability <br />106119195 <br />112112014 <br />121/2015 <br />Per Claim $1,000,000 <br />Claims Made <br />Annl Aggr $2,000,000 <br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 1D1, Additional Remarks Schedule, If more space is required) <br />General Liability policy excludes claims arising out of the performance of professional services. <br />Independent Contractors Included as respects to General Liability. <br />10 Day Notice of Cancellation/10 Day notice for Non -Payment of Prem <br />Re: On Call Engineering Services City of Santa Ana, its officers, employees, agents, volunteers and representatives are additional insured as <br />respects to General Liability as required by written contract. Primary and Non -Contributing coverage applies to GL as required by written <br />contract. <br />CERTIFICATE HOLDER CANCELLATION <br />©1988.2010 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />City of Santa Ana <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />20 Civic Center Plaza -Ross Annex (M-36) <br />Santa Ana CA 92701 <br />AUTHORIZED REPRESENTATIVE <br />l°1` JI,a,f] <br />©1988.2010 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD <br />