|
ACCOR0b CERTIFICATE OF LIABILITY INSURANCE
<br />16.�
<br />DATE(MMIDDIYYYY)
<br />3/22/2016
<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(les) must be endorsed. If SUBROGATION IS WAIVED, sublDct 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).
<br />PRODUCER
<br />NAMT CT Certificate Department
<br />Cavignac & AssociatesPHONe
<br />450 B Street, Suite 1800
<br />San Diego, CA 92101-8005
<br />PAx
<br />VA/C Nn Hsi), 619-2'34-6848 (AIC. Ne)•619-234-8601
<br />ADORIEeS; Certif Kates®Cavignao.com
<br />INSURER(S) AFFORDING COVERAGE
<br />NAIC6
<br />License No, OA99520
<br />INSURER A: o rn OR'AME
<br />EACI I OCCURRENCE $ 1,000,000
<br />DA9AGE-
<br />i0 KENS
<br />PREMISES I'E Ee and Curry) $ 1, DCO, 000
<br />INSURED
<br />Rick Engineering Company
<br />5620 Friars Road
<br />INSURERS: TRAVELERS IND CO OF CT
<br />25682
<br />INsuaeRc: XL SPECIALTY INS CO
<br />37885
<br />INSURER O:
<br />San Diego, CA 92110 United States
<br />INSURERS:
<br />X Contratltual Liability
<br />NSURERPI
<br />COVERAGES CERTIFICATE NUMBER: 365650 REVISION NUMBER:
<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 />TORINR
<br />TYPE OF INBURANCBla&
<br />A L
<br />U
<br />VD
<br />POLICY NUMBER
<br />POLICY EFF
<br />MMIDD
<br />POUCY BXP
<br />Mltl
<br />LIMITS
<br />B
<br />GENERAL LIABILITY
<br />69072926137
<br />1/1/2016
<br />1/1/2017
<br />EACI I OCCURRENCE $ 1,000,000
<br />DA9AGE-
<br />i0 KENS
<br />PREMISES I'E Ee and Curry) $ 1, DCO, 000
<br />X COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE D OCCUR
<br />MED EXP (Anyone person $ 10,000
<br />_
<br />PERSONAL &ADV INJURY $ 1, 000, OOD
<br />X Contratltual Liability
<br />X
<br />X separation of Insureds
<br />GENERAL AGGREGATE_ $ 2, 000, 000
<br />GENE AGGREGATE
<br />LIMIT APPLIES PER:
<br />PRODUCTS - COMPIOP AGO $ 2,000,000
<br />POLICY
<br />X JECT PRD LOC
<br />I
<br />I
<br />Deductible $ p
<br />A
<br />AUTOMOBILE
<br />LIABILITY
<br />BA7276LE22
<br />1/1/2016
<br />1/1/2017
<br />OM51?Ed see EDSINGLE LIMIT 1, DOD, 000
<br />BODILY INJURY (Per person) $
<br />X
<br />ANY AUTO
<br />ALL OWNED SCHEDULED
<br />AUTOS AUTOS
<br />BODILY INJURY Per acdden0 IS
<br />HIRED AUTOS AUUTOSWNFD
<br />a1 PcddenuAMAGE
<br />$
<br />UMBRELLA LIAR
<br />H
<br />OCCUR
<br />EACH OCCURRENCE $
<br />AGGREGATE $
<br />EXCESS LIAR
<br />CLAIMS -MAGE
<br />DEO I RETENTION
<br />$
<br />A
<br />WORKERS COMPENSATION
<br />ANOEMPLOYERS'LIABILITY YIN
<br />ANY PROPRIETORIPARTNERIEXECLITIVE
<br />OPFICERIMBNRER EXCLUDED?
<br />NIA
<br />UB]B33T]79
<br />1/l/2016
<br />1/1/2017
<br />X WC BTATU- UTH-
<br />htMUTS—.
<br />E.L. EACH ACCIDENT $ 1,000,000
<br />EL, DISEASE - EA EMPLOYEE,$ 1,000, DUO
<br />(Mandatory in NH)
<br />If yes, dascrbe under
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE, POLICY LIMIT IS 1 OOU 000
<br />C
<br />Professional Liability
<br />DPR9725305
<br />A/15/2015
<br />9/15/2016
<br />Each Claim $3,000,000
<br />Aggregate $8,000,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ANach ACORD 101, Addltensl Remarks Scheduin, IP more space is required)
<br />Additional Insured eovorage applies to General Liability Ear City of Santa Ana, its officers, employees, agents,
<br />volunteers and repreeentativea per policy form. Primary coverage applies to General Liability per policy form. Prof,
<br />Lisa. - Claims made, defense costa included within limit. if the insurance Company elects to cancel or non -renew
<br />coverage for any reason other than nonpayment of premium Cavignac & AoSociates will provide 30 days notice of such
<br />cancellation or nonrenewal.
<br />REVIEWED BY: EUNICE HEREDIA (PG IOF Z)
<br />CERTIFICATE HOLDER CANCELLATION
<br />City of Santa Ana
<br />20 Civic Center Plaza NI -30
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />PO Dox 1989
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />,Santa Ana., CA 92702-1989
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />United States
<br />AUTHORIZED REPRESENTATIVE l
<br />1Yr,�
<br />Jeffrey W. Cavignac I/4
<br />V
<br />©1968.2010 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD
<br />EXIGIS - CAViGNAC & ASSOCIATES 386452
<br />Uonn I nF A
<br />
|