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KlATInNIAI F)ATA AKIF) CY I \1L-VIN.IY`. Q1=rjk!1'..(' C:Q A Onl') Ir -0 OMPflMA/mn OV- a° .^"•f' R n rl 111111_ar_[1e1A rrrr'+
<br />CERTIFICATE CSF
<br />LIABILITY lh-kR;ANICE
<br />DATE{MM1D.-. ...
<br />DfYYYY)
<br />9124/2015
<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, EXTENDOR 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 conditl'ons 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).
<br />PRODUCER
<br />ROSEWOOD, RISK MGMT & I'NS SOLUTIONS
<br />7162 Beverly Blvd, Ste 180
<br />Los Angeles, CA 90036
<br />OH38577
<br />NONTACTYehuda Kaplan
<br />PHONE ( ) -3081 FAX (323) 800-6745
<br />E-MAIL ykaplan@r=is.com
<br />INSURERS AFFORDING COVERAGE NAIL#
<br />Penn Starr Insurance Company 10673
<br />INSURED National Data a.ndl. Surveying Services
<br />8370 Wilshire Blvd., Ste 205
<br />Beverly Hills, CA 90211
<br />(323) 782-0090
<br />COMMERCIAL GENERAL LIABILITY
<br />INSURER B: west Awn rican Ins. Co (Lib—ty Mutalal,) 44393
<br />INSURrRCITorus National Insurance Company 25496
<br />INSURER D: Zurich American Insurance Company 16.535
<br />IN
<br />�kJULU L,N
<br />r`.CIA/1=PA/:,F:R. r...P=PTIFIC..ATF NII INAAPP- CiC1lICE(1RI NII INAPPr?.
<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 BYPAM CLAIMS,
<br />IR
<br />LTR
<br />TYPE OF INSURANCE
<br />Pot ICY NUMBER
<br />POLICY EFF
<br />M t7 /YYYY�l
<br />POLICY EXP
<br />�MMMMYYYY1
<br />LIMITS
<br />COMMERCIAL GENERAL LIABILITY
<br />EACH OCCURRENCE $ 1,000',000
<br />00
<br />PREMISESire n $ 100 0'
<br />CLAIMS -MADE El OCCUR
<br />MED EXP (Anyone pe,son7 $ 5,000
<br />CPV0001042 (CA,WA, TN)'
<br />)
<br />9,r 17// 159,/
<br />/
<br />17f 16
<br />A'
<br />Y
<br />Y
<br />PAV0054346 (.GA,. FL NC)
<br />PERSONAL BADV INJDRY s 1 000' 000'.
<br />GENERAL AGGREGATE; s 2,000,000
<br />GENT AGGREGATE LIMIT APPLIES PER:
<br />RPOLICY PRO-
<br />JECT [:]LOC
<br />PRODUCTS - COMP/OP AGG $ Included
<br />Ded. $ 2,500'
<br />OTHFIR
<br />AUTOMOBILE LIABILITY
<br />COMBINED SINGLE LIMIT
<br />E $ , ,
<br />BODILY INJURY (Per person) $
<br />X ANYAUTO
<br />SAW (TF') 55 Bit 83 T.3
<br />/
<br />9/ 17159/.7/
<br />y / 1'�7
<br />B
<br />ALLOWNED SCHEDULED'
<br />'{
<br />AUTOS AUTOS
<br />Y
<br />Y
<br />BODILY INJURY (Per accident)
<br />yi HIRED AUTOS i{ NON -OWNED
<br />AUTOS
<br />PROPERTY DAMAGE, $
<br />Wer accident)
<br />$
<br />...00CUR
<br />UMBRELLALIAd3
<br />,'
<br />EACH OCCURRENCE $ 5, 0010', 0010'
<br />Imo'EXCESS
<br />RI
<br />LIAR
<br />CLAIMS -MADE
<br />Y
<br />Y
<br />77763Yi152ALI
<br />9/17/159/17/16
<br />AGGREGATE $ 5,005,0
<br />DED I I RETENTION$ 10,000
<br />WORKERS COMPENSATION
<br />% PER OTH-
<br />TAT 1T
<br />AND EMPLOYERS' LIABILITY
<br />ANY PROPRIE:TORIPARTNERI XE.CUTIVE. Y N
<br />F1 d'f
<br />WC 9'407597^02
<br />9/17/159/17/16
<br />E..L.EACH AGCGD$ '", 00'0 p 0010..
<br />D
<br />OPFICERIMEMBER EXCLUDED'?
<br />NIA
<br />Y
<br />F.L. DISEASE - FA�EMPLOJYEE$ , ,
<br />(Mandator/ in NH)
<br />If yes, describe under
<br />DE RVF•aTl N F PERATI NS bel ,a,.
<br />E.L.DISEASE - 1,000 ,. , 0'
<br />Commercial GL
<br />Per Occ: $1,000,00'0
<br />A
<br />PAV0054346
<br />Y
<br />Y'PAV0054346
<br />9/17/159/17/16
<br />Gen Agg: $2,000,0010
<br />Outside ('CA)
<br />DESCRIPTION OF OPERATIONS / LOCATIONS f VEHICLES (ACORD 101, Additional Remarks Schedule, ma'y pe adkached if more space Is re�quilredp
<br />CITY OF" SANTA, ANA. PUBLIC WORKS its Officers, employees, and agents are provided
<br />additional insured status on a primary and noncontributory basis as required by
<br />written contract or agreement. A Waiver of Subrogation is in favor of the
<br />additional insured.
<br />30 Days Notice of Cancellation, 10 Days for Nan Payment of Premium..
<br />CITY OF ,SANTA ANA PUBLIC WORKS SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />20 CIVIC CENTER PLAZA THE EXPIRATION. DATE. THEREOF, NOTICE WILL. BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />SANTA ANA, CA 92701
<br />AUTHORIZED REPRESENTATIVE
<br />9 1988-2014 ACORD RPORATION. All bights reserved.
<br />ACORD 25 (20114/01) The ACORD name and logo are registered marks of ACORD
<br />
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