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<br />f`Ni....A. CERTIFICATE OF LIABILITY INSURANCE3/30/2017
<br />DATE (MMtDDIYYYY)
<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 endorsement(s).
<br />PRODUCER
<br />Cavic�nac &Associates
<br />450 B Street, Suite 1800
<br />San Diego CA 92101
<br />Certificate Department
<br />_NAMEACT
<br />PHONE PAX
<br />o Ext), 619 744-0574 (ALC No); 619-234-IIs01
<br />EMAIL ,certificates@cavignaa.com
<br />INSURER(S) AFFORDING COVERAGE NAIC If
<br />Y
<br />INSURER A :Travelers Indemnity Co of Conn 25682
<br />6806H046886
<br />INSURED RICKENG-01
<br />INSURERB:XL Specialty Company
<br />Rick Engineering Company
<br />INSURER c :Travelers Property & Casualty Coma 25674
<br />5620 Friars Road
<br />San Diego, CA 92110
<br />INSURER D
<br />INSURER E:
<br />INSURER F:
<br />COVERAGES CERTIFICATE Nt1MRER: 1440061823 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 />ILTR
<br />TYPE OF INSURANCE
<br />I gD
<br />WVO
<br />POLICY NUMBER
<br />POLICY EFF
<br />AMILDD1YyYY
<br />LIMITS
<br />A
<br />X COMMERCIAL GENERAL LIABILITY
<br />Y
<br />6806H046886
<br />1/1/2017
<br />1/1/2018
<br />EACH OCCURRENCE $1,000,000
<br />CLAIMS -MADE X❑ OCCUR
<br />_
<br />DAMAGE TO RENTED 1MISES Ea o urrence $11000,000
<br />E
<br />MED EXP (Any one person) $10,000
<br />X Senarallon of in
<br />PERSONAL & ADV INJURY $1,000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />GENERAL AGGREGATE $2,000,000
<br />X POLICY JETO. � LOC
<br />PRODUCTS -COMP/OP AGG $2,000,000
<br />Deductible $0
<br />OTHER:
<br />C
<br />AUTOMOBILE
<br />LIABILITY
<br />BA72761_522
<br />1/1/2017
<br />1/1/2018
<br />cc$1idem $1,000,000
<br />BODILY INJURY (Per person) $
<br />X1AUTOS
<br />ANYAUTO
<br />ALL OS NED SSCHrODULED
<br />BODILY INJURY (Per accident) $
<br />HIRED AUTOS NON -OWNED
<br />L
<br />PROPERTY DAMA E $
<br />Per accident
<br />$
<br />UMBRELLA LIAR
<br />HCLAIMS-MADE
<br />OCCUR
<br />EACH OCCURRENCE $
<br />AGGREGATE $
<br />EXCESS LIAR
<br />DED I I RETENTION$
<br />$
<br />C
<br />WORKERS COMPENSATION
<br />AND EMPLOYER S'LIABILITY YIN
<br />ANY PROPRIETOR/PARTNERIEXECUTIVEElNIA
<br />U6611924546
<br />1/1/2017
<br />1/1/2016
<br />XPER orH-
<br />STATUTEER
<br />E.L,EACHACCIDENT $1,000,000
<br />OFFICERIMEMBER EXCLUDED?
<br />E.L. DISEASE - EA EMPLOYE $1,000,000
<br />(Mandatory in NH)
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />EL. DISEASE - POLICY LIMIT $1,000,000
<br />B
<br />Professional Liability
<br />DPR9808320
<br />8/15/2016
<br />8/15/2017
<br />Each Claim $3,000,000
<br />L_L
<br />Aggregate $8,000,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required)
<br />Additional Insured coverage applies to General Liability for City of Santa Ana, Its officers, employees, agents, volunteers and representatives
<br />per policy form. Primary coverage applies to General Liability per policy form. Prof. Liab, - Claims made, defense costs included within limit. If
<br />the insurance company elects to cancel or non -renew coverage for any reason other than nonpayment of premium Cavignac & Associates
<br />will provide 30 days notice of such cancellation or nonrenewal.
<br />REVIEWED kY .. _ E LYC IOC E HC,FELiIA (PC �_. r._....�
<br />CERTIFICATE HOLDER CANCELLATION
<br />@ 1988.2014 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2014101) 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 />20 Civic Center Plaza M-30
<br />ACCORDANCE WITH THE POLICY PROVISIONS,
<br />PO Box 1988
<br />Santa Ana CA 92702-1988
<br />AUTHORIZED REE/PRESENTATIVE
<br />4 F Kr
<br />@ 1988.2014 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD
<br />
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