RINCCON-n1
<br />PHII 1 IPCr`
<br />o CERTIFICATE OF LIABILITY INSURANCE
<br />n`.
<br />DATY)
<br />2/1/2
<br />211/201188
<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 have ADDITIONAL INSURED provisions or be endorsed.
<br />If SUBROGATION IS 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 License#OE67768
<br />NQINTEACT Elizabeth Leach
<br />Legends Environmental Ins. Services
<br />130 Vantis
<br />Suite 250
<br />Allso Viejo, CA 92656
<br />PHONE FAX
<br />AIc, IN Eau): (949) 297-5537 52011 (Alc, N.):(949) 297-5960
<br />AEb%A,'L5ss, Elizabeth. Leach@ioausa.com
<br />INSURER B AFFORDING COVERAGE NAIC p
<br />INSURER A: Crum ✓£ Forster Specialty Insurance Company 44520
<br />X
<br />INSURED
<br />INSURER B: Trumbull Insurance Company 27120
<br />INSURER C:StarStone National Insurance Company 25496
<br />Rincon Consultants, Inc. b/
<br />INSURER D
<br />210 N Ashwood Ave
<br />Ventura, CA 93033
<br />DAMAGE TO RENTED
<br />occurrsn
<br />50,000
<br />NSURER E
<br />NSURERE:
<br />$ 10,000
<br />COVFRAr;FS CFRTIFICATF NIIMRFR- oP%/IQInNI NII Il,RRCG.
<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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
<br />CERTIFICATE MAYBE 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 />LT
<br />TYPE OF INSURANCE
<br />ADDLSuss
<br />❑
<br />D
<br />POLICY NUMBER
<br />POLICY EFF
<br />POLICY EXP
<br />LIMITS
<br />A
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE X OCCUR
<br />Transportation Poll.
<br />X
<br />X
<br />EPKI14155
<br />09122/2016
<br />09/22/2018
<br />EACH OCCURRENCE
<br />-
<br />$ 3,000,000
<br />DAMAGE TO RENTED
<br />occurrsn
<br />50,000
<br />X
<br />MED EXP (Any one erson
<br />$ 10,000
<br />PERSONAL &ADV INJURY
<br />$ 3,000,000
<br />LIMIT APPLIES PER:
<br />POLICY ® JE� El LOC
<br />GENERAL AGGREGATE
<br />$ 4,000,000
<br />GEN'LAGGREGATE
<br />PRODUCTS-COMP/OPAGG
<br />4,000,000
<br />X
<br />OTHER: Contractors Pollution Liability
<br />Deductible
<br />2,500
<br />B
<br />AUTOMOBILE
<br />LIABILITY
<br />COMBINEDSINGLE LIMIT
<br />Ea accident
<br />$ 1,000,000
<br />BODILY INJURY Per erson
<br />$
<br />X
<br />ANY AUTO
<br />AAUTOS ONLY SCHEDULED
<br />X
<br />X
<br />72UUNPT4318
<br />12/17/2017
<br />12117/2018
<br />w.-
<br />BODILY INJURY Per accident
<br />$
<br />X
<br />X
<br />AIIRTOS ONLY X NO -OS ONLY
<br />Pion oil Oetl
<br />S$MBRELLA
<br />PerOaaolRdnt AMAGE
<br />A
<br />LIAB
<br />X
<br />OCCUR
<br />EACH OCCURRENCE
<br />$ 5,000,000
<br />X
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />EFX108624
<br />09/2212017
<br />09/22/2018
<br />AGGREGATE
<br />$ 5,000,000
<br />DEO 7X I RETENTION$ 10,000---
<br />C
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY YIN
<br />AApNNpY PROPRIETOR/PARTNER/EXECUTIVE
<br />(MandER/MatoryEM NER EXCLUDED? �
<br />If yes, describe under
<br />-DESCRIPTION OF OPERATIONS below
<br />NIA
<br />X
<br />710180329
<br />02/01/2018
<br />02/01/2019
<br />_-
<br />�( PER OTH-
<br />ER
<br />E. L. EACH ACCIDENT
<br />$ 11000,000
<br />E.L. DISEASE - EA EMPLOYE
<br />$ 1,000,000
<br />E.L. DISEASE -POLICY LIMIT
<br />1,000,000
<br />A
<br />Professional Llab.*
<br />EPK114155
<br />09/22/2016
<br />09/22/2018
<br />Per Claim
<br />3,000,000
<br />A
<br />Professional Liab.*
<br />EPKI14155
<br />09122/2016
<br />09/2212018
<br />Aggregate
<br />4,000,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD iDi, Additlonal Remarks Schedule, maybe attached If more space Is required)
<br />*Professional Liability and Transportation Pollution Liability are written on a Claims Made basis. When required by written contract, the General Liability and
<br />Pollution Liability Limits are on a Per Project basis while dedicated; the Professional Liability is on a Per Policy basis. Professional Liabilty Deductible $10,000
<br />Each Claim.
<br />The City of Santa Ana and Community Development Agency, 20 Civic Center Plaza, M-26 Santa Ana, CA 92702, their officers, employees, agents and
<br />volunteers are included as additional insureds for General Liability and Auto Liability with respect to work performed for them by the Named Insured as
<br />required by written contract, per Blanket Additional Insured endorsement EN0147.1111, EN0320-0211, EN0321-0211 & HA99160312. Liability Coverage is
<br />SEE ATTACHED ACORD 101
<br />4;CIty� of Santa Ana
<br />20 Civic Center Plaza, M-26
<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 />ACORD 25 (2016/03) @ 1988-2015 ACORD CORPORATION. All rights reserved.
<br />The ACORD name and logo are registered marks of ACORD
<br />
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