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AC R" CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDlYYYY)
<br />1 0812212018
<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 INSURERS), AUTHORIZED
<br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
<br />IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed.
<br />If SUBROGATION 1S WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on
<br />this certificate does not confer rights to the certificate holder In lieu of such endorsement(s).
<br />PRODUCER Bill Douglas Kourls Insurance Agency,inc NAME: CONTACT _
<br />10345 Danichr)s Way PHONE 916-236-5641 lac Nor916.685-9571
<br />Elk Grove CA 95757 FA n'L.ea. bdkinsurance0amail.com
<br />INSURED Bender Rosenthal, Inc,
<br />2825 Watt Avenue, Suite 200
<br />Sacramento CA 95821
<br />INSURER A,Houston Casualty Company I42374
<br />„,grr.F...Travelers Property Casualty Co of America 125B74
<br />COVERAGES CERTIFICATE NUMBER: RFVIRIAN NIIMRPR,
<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 />INBR ----_.. -- __-._--- AObt 9U8R _.._-.._......._ _..__..... _ _
<br />—POLICY EfFPOLICY EXP---"'---"_. .._.._ ............. ..
<br />LTR TYPE OF INSURANCE POLICY NUMBER MMIDDIYYYY MMIDDfyyyyl LIMITS
<br />B
<br />I/
<br />COMMERCIAL GENERAL LIABILITY
<br />EACHOCCURRENCE
<br />S1,000,000
<br />✓
<br />630-9K104459-TIL-18
<br />6/0112018
<br />OW0112019
<br />CLAIMSWADE OCCUR
<br />.pAM'1OES.(Eoocc_DIfpR4o)..__
<br />$100,000
<br />A1ED C-XP (Any ona parson)
<br />$ 5,000
<br />J
<br />PERSONAL 6 ADV INJURY
<br />$1,000,000
<br />GEN'L
<br />AGGREGATE LIMIT APPLIES PER;
<br />GENERAL AGGREGATE
<br />s2,000,000
<br />PRO-
<br />POLICY a JECT LOC
<br />..-..._.. ..
<br />PRODUCTS-COMPIOP AGG
<br />s2,000,000
<br />$
<br />OTHER:
<br />AUTOMOBILE LIABILITY
<br />✓
<br />t/
<br />COMBINED SINGLE LIMIT
<br />S 1 000 000
<br />ANY AUTO
<br />BODILY INJURY (Per person)
<br />S
<br />OWNED ✓ SCHEDULED
<br />AUTOS ONLY AUTOS
<br />BODILY INJURY (Par accident)
<br />S
<br />B
<br />HIRED NO N-0WNED
<br />✓ ✓
<br />BA-9K106686-18-14
<br />6/0112018
<br />06/01/2019
<br />PROPERTY DAMAGE-�
<br />ERTYE
<br />S
<br />AUTOS ONLY AUTOS ONLY
<br />(per
<br />B
<br />UMBRELLA LIAR ✓ OCCUR
<br />✓
<br />✓
<br />EX-9K117560-18-14
<br />6/0112018
<br />06/01/2019
<br />EACH OCCURRENCE
<br />$ 5,000,000
<br />AG_G_REGATE
<br />$ 5,000,000
<br />EXCESS LIAB CLAIMS -MADE
<br />GL, Auto and WC form
<br />T '
<br />DED RETENTIONS
<br />I$
<br />B
<br />WORKERS COMPENSATION
<br />$/
<br />UB-9K107321-18-14
<br />610112018
<br />06/01/2019
<br />✓ PEREOT
<br />RH-
<br />AND EMPLOYERS' LIABILITY
<br />E.L. EACH ACCIDENT
<br />$1,000,000
<br />DFC ERPRIETOREXRTNCLUED9ECUTIVE a
<br />NIA
<br />E.L. DISEASE - EA EMPLOYEE
<br />S1,000,000
<br />(Mandatory In NH)
<br />If es, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />I
<br />E.L. DISEASE - POLICY LIMIT
<br />S 1,000,000
<br />H717-110662
<br />A�Pcfim-SMADE
<br />slonal Liabilit Y
<br />Q
<br />O
<br />Deductible 15,000
<br />113012017
<br />11/30/2018
<br />$2,000,000 Per regateOccurrenc
<br />52,000,000 Aggregale
<br />Retro Date 11130/99
<br />DESCRIPTION OF OPERATIONS/ LOCATIONS VEHICLES (ACORD tat, Addlllonal Remarks Schedule, maybe attached If more space Is rectulred)
<br />30 Days Notice of Cancellation/10 Days for Non -Payment IL02700912
<br />Job: On -Call Right of Way Appraisal Services Per Written Contract, Project Per Written Contract
<br />COMMERCIAL GENERAL LIABILITY BLANKET ADDITIONAL INSURED/PRIMARYINON-CONTRIBUTORYIWAIVER OF SUBROGATIONIHOLD
<br />HARM LESSNNSUREDS-SUBCONTRACTOR, OUR WORK PER PROJECT OR LOCATION: CGD2460805 Per Written Contract
<br />COMMERCIAL AUTO BLANKET ADDITIONAL INSURED/PRIMARYIWAIVER OF SUBROGATIONIEMPLOYEES AS INSUREDS: CAT3530216 Per
<br />Written Contract. WORKERS' COMPENSATION WAIVER OF SUBROGATION: WC990376(A)-001 Per Written Contract
<br />UMBRELLA: Any Person Qualifying as such under underlying General Liability, Commercial Auto, and Workers' Com ` nsation Insurance.
<br />Additional Insured: City of Santa Ana, Its officers, employees, agents, volunteers, a d.renresentatiVAR
<br />'
<br />REVIEWED BY: EUNICE HEREDIA (PG
<br />City of Santa Ana
<br />20 Civic Center Plaza M-30
<br />PO Box 1988
<br />Santa Ana, CA 92702-1988
<br />Letica Lopez, Lfopez5@santa-ana.org
<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 />@ 19OB-2015 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD
<br />Produced using Forma Boas Web Software, www.Formal3os3.com (c) Impressive Publishing 800.200-1977
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