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,4.CQRG►�CERTIFICATE OF LIABILITY INSURANCE
<br />�w.....�-"'
<br />DATD/YYYY)
<br />8/14/20172017
<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 />Cavignac & Associates
<br />450 B Street, Suite 1800
<br />San Diego CA 92101
<br />CONTACT
<br />NAME: Certificate Department
<br />PHONE 619-744-0574 FAx
<br />_(ALC,_Ua_F-)• A/c Nel: 619-234-8601
<br />IL S$; certificates@cavignac.com
<br />E-MARE
<br />INSURERS AFFORDING COVERAGE NAIC #
<br />Y
<br />INSURER A: Travelers Pro ert& Casualty Coma 25674
<br />6806HO46886
<br />INSURED RICKENG-01
<br />INSURERB:XL Specialty Com an '...37885
<br />Rick Engineering Company
<br />5620 Friars Road
<br />INSURER C:
<br />MED EXP (Any one person) $10,000
<br />San Diego, CA 92110
<br />INSURER D:
<br />_
<br />INSURER E:
<br />INSURER F:
<br />COVERAGES CERTIFICATE NUMBER: 1673738495 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 />INSR
<br />LTR
<br />I TYPE OF INSURANCE
<br />ADDLISUBR
<br />INSD
<br />WVD
<br />POLICY NUMBER
<br />POLICY EFF
<br />MM/DD/YYYY
<br />POLICY EXP
<br />MM/DD/YYYY
<br />LIMITS
<br />A
<br />X '', COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE 5X OCCUR
<br />Y
<br />6806HO46886
<br />1/1/2017
<br />1/1/2018
<br />EACH OCCURRENCE $1,000,000
<br />DAMAGES(R NTED
<br />PREMISES Ea occurrence) $1,000,000
<br />MED EXP (Any one person) $10,000
<br />X Separation 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 JE� LOC
<br />PRODUCTS - COMP/OP AGG $2,000,000
<br />Deductible $0
<br />OTHER:
<br />A
<br />AUTOMOBILE LIABILITY
<br />BA7276L522
<br />1/1/2017
<br />1/1/2018
<br />co E INGLE LIMIT
<br />Ea accident $1,000,000
<br />X ANY AUTO
<br />BODILY INJURY (Per person) $
<br />ALLOWNED SCHEDULED
<br />BODILY INJURY (Per accident) $
<br />NON -OWNED
<br />HIRED AUTOS AUTOS
<br />PROPERTY DAMAGE $
<br />Paraccident
<br />$
<br />UMBRELLA LIAB
<br />HOCCUR
<br />EACH OCCURRENCE $
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />AGGREGATE $
<br />RETENTION $
<br />$
<br />A
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY Y / N
<br />UB6H924546
<br />1/1/2017
<br />1/1/2018PER
<br />OTH-
<br />X STATUTE ER
<br />EACH ACCIDENT $1,000,000
<br />ANY PROPRIETOR/PARTNER/EXECUTIVEE.L.
<br />OFFICER/MEMBER EXCLUDED? ❑
<br />N / A
<br />_
<br />E.L. DISEASE - EA EMPLOYEE $1,000,000
<br />(Mandatory in NH)
<br />If yes, describe under
<br />--
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE - POLICY LIMIT $1,000,000
<br />B
<br />Professional Liability
<br />DPR9916964
<br />8/15/2017
<br />8/15/2018
<br />Each Claim $3,000,000
<br />Aggregate $8,000,000
<br />DESCRIPTION OF OPERATIONS / LOCATIONS [VEHICLES (ACORD 101, Additional Remarks Schedule, maybe 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 policv 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 />RFVIEtNEC) BY: EUNIC:E HEREDIA ('G F )
<br />c____.___:. _IO
<br />�
<br />%.r -R i irwro t c nvt_vr_rc
<br />City of Santa Ana
<br />20 Civic Center Plaza M-30
<br />PO Box 1988
<br />Santa Ana CA 92702-1988
<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 />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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