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<br />AC`C )R" CERTIFICATE OF LIABILITY INSURANCE
<br />�.....--'"
<br />DATE(MMDD/YYYY)
<br />7/14/2015
<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 be endorsed. If SUBROGATION 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 endorsements .
<br />PRODUCER
<br />Dealey, Renton & Associates
<br />License #0020739
<br />P. O. Box 10550
<br />CONTACT
<br />NAME:
<br />PHONE FAX
<br />E-MAIL
<br />Santa Ana CA 92711-0550
<br />INSURERS AFFORDING COVERAGE NAIC #
<br />INSURERA:Travelers Casualty & Surety Co. Ame 31194
<br />7/21/2016
<br />INSURED
<br />INSURER B :American Automobile Ins. Co. 21849
<br />PENCO Engineering, Inc.
<br />INSURERC:Associated Indemnity Corp.
<br />16842 Von Karman Avenue, Suite 150
<br />Irvine CA 92606
<br />INSURER D:
<br />INSURER E
<br />INSURER F:
<br />MED EXP Any one person) $10,000
<br />COVERAGES CFRTIFICATF NIIMRFR- 705082496 RFVLSIr1N NI IMRI=l
<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 />TR
<br />TYPE OF INSURANCE
<br />INSD
<br />WVD
<br />POLICY NUMBER
<br />MM DDYIYYYY
<br />EXP
<br />MM DDY
<br />LIMITS
<br />C
<br />X COMMERCIAL GENERAL LIABILITY
<br />AZC80905277
<br />7/21/2015
<br />7/21/2016
<br />EACH OCCURRENCE $1,000,000
<br />CLAIMS -MADE EX OCCUR
<br />DAMAGE TO RENTED
<br />PREMISES Eaoccu ence $1,000,000
<br />MED EXP Any one person) $10,000
<br />X Contractual
<br />X BFPD XCU
<br />PERSONAL &ADV INJURY $1,000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />GENERAL AGGREGATE $2,000,000
<br />POLICY PRO-
<br />JECT[::] LOC
<br />PRODUCTS - COMP/OP AGG $2,000,000
<br />$
<br />OTHER:
<br />B
<br />AUTOMOBILE
<br />LIABILITY
<br />MZA80312991
<br />7/21/2015
<br />7/21/2016
<br />COMBINED SINGLE LIMIT $
<br />Ea accident 1,000,000
<br />BODILY INJURY (Per person) $
<br />X
<br />ANY AUTO
<br />AUTS OWNED SCHEDULED
<br />BODILY INJURY (Per accident) $
<br />X
<br />HIRED AUTOS X NON -OWNED
<br />AUTOS
<br />PROPERTY DAMAGE $
<br />Per accident
<br />$
<br />UMBRELLA LIAR
<br />OCCUR
<br />EACH OCCURRENCE _ _ $
<br />AGGREGATE $
<br />EXCESS LAB
<br />CLAIMS -MADE
<br />DED RETENTION $
<br />$
<br />B
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY Y / N
<br />WZP81028890
<br />7/21/2015
<br />7/21/2016
<br />X PER OTH-
<br />STATUTE ER
<br />E.L. EACH ACCIDENT $1,000,000
<br />ANY PROPRIETOR/PARTNER/EXECUTIVE
<br />OFFICER/MEMBER EXCLUDED?
<br />N / A
<br />E.L. DISEASE - EA EMPLOYE $1,000,000
<br />(Mandatory in NH)
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />-
<br />E.L. DISEASE - POLICY LIMIT 1 $1,000,000
<br />A
<br />Professional Liability
<br />Claims Made
<br />106119195
<br />7/21/2015
<br />7/21/2016
<br />Per Claim $1,000,000
<br />Annl Aggr $2,000,000
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached 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 />1,1-11III-ILAIt MULL/t11 t;ANI.:LLLAIIUN
<br />City of Santa Ana
<br />20 Civic Center Plaza -Ross Annex (M-36)
<br />Santa Ana CA 92701
<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 />AUTHORIZED REPRESENTATIVE
<br />©1988-2014 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD
<br />
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