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IkiIus] 1097e7.Q1y7
<br />ALISTINA
<br />. 1`%� R CERTIFICATE OF LIABILITY INSURANCE
<br />`018
<br />DATE 5/10/210/2 D,YYYY)
<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 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 />IOA Insurance Services
<br />4370 La Jolla Village Drive
<br />Suite 600
<br />CONAMTA
<br />NE: CT Erica Wilson
<br />PHONE
<br />(A/C, No, Ext): (858) 754-0063 50233 jac, No):(619) 574-6288
<br />EMAIL rca.son loausa.com
<br />ADDRESS: Erica.Wilson@ioausa.com
<br />San Diego, CA 92122
<br />AFFORDING COVERAGE
<br />NAIC #
<br />INSURER A:RLI Insurance Company
<br />13056
<br />INSURED INSURER B: Crum 8r Forster Specialty Insurance Company
<br />44520
<br />Nichols Consulting Engineers, CHTD INSURERC:
<br />1885 S. Arlington Ave., #111 INSURERD:
<br />Reno, NV 89509
<br />INSURER E :
<br />INSURER F :
<br />COVFRAGFS CFRTIFICATF NLIMRFR- RFVIRIAN NIIMRFR-
<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 ADDL SUBR ^POLICY EFF POLICY EXP LIMITS
<br />LTIR TYPE OF INSURANCE POLICY NUMBER
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />,EACH OCCURRENCE $ 1,000,000
<br />CLAIMS -MADE [j OCCUR
<br />u
<br />X
<br />pS60003222 05/17/2018
<br />_
<br />AMAGE TO RENTED 1,000,000
<br />05/17/2019 �EIES--IEa_aecuaa $
<br />Cont Liab/Sev of Int
<br />I ---------
<br />10,000
<br />X
<br />MED EXP (Any one rson) $
<br />LPERSONAL 8 ADV INJURY _ 1,000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />!GENERAL AGGREGATE $ 2,000,000
<br />❑X JECT
<br />-_
<br />2 OOO,OOO
<br />POLICY _ LOC
<br />PRODUCTS-COMP/OPAGG $
<br />OTHER:
<br />,Deductible 0
<br />A
<br />AUTOMOBILE
<br />LIABILITY
<br />COMBINED SINGLE LIMIT 1,000,000
<br />1Ea_accident) I $
<br />X
<br />ANY AUTO
<br />X
<br />PSA0001184 05/17/2018
<br />05/17/2019 j BODILY INJURY Per person i $
<br />_
<br />SCHEDULED
<br />AUTOS
<br />ONLY AUTOS
<br />BOORDILY INJUppRY (Per acc(dent $__-_-
<br />Ep
<br />AUTOS ONLY AUTOS ONNLY
<br />-
<br />(PeOacEclRden rMAGE - -- - -- - __--
<br />X
<br />Comp.: $500 X 'iColl.: $500$--_-
<br />,
<br />A
<br />UMBRELLA LIAB
<br />X
<br />OCCUR
<br />EACH OCCURRENCE $ 5,000,000
<br />X
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />PSE0003030 ',! 05/17/2018
<br />05/17/2019 AGGREGATE 5,000,000
<br />DED RETENTION $
<br />j
<br />A
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY
<br />!
<br />X PER PTtTI,IT�-_- _ERH -, _
<br />-
<br />ANYPROPRIETOR/PARTNER/EXECUTIVE Y/-N
<br />X
<br />PSWOOO1955 05117/2018
<br />05/17/2019 1,000,000
<br />E.L..EACH ACCIDENT $
<br />OFFICER/MEMBER EXCLUDED?
<br />(Mandatory in NH) -
<br />N / A
<br />_ _- _
<br />E.L. DISEASE - EA EMPLOYEE $ 1,000,000
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />- _- -
<br />E.L. DISEASE - POLICY LIMIT 1,000,000
<br />B
<br />Prof Liab/Clms Made
<br />PKC107494 05/17/2018
<br />05/17/2019 Per Claim 2,000,000
<br />B
<br />Ded.: $10k Per Claim
<br />I
<br />PKC107494 05/17/2018
<br />05/17/2019 Aggregate 2,000,000
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
<br />Re: Agreement Nos. N-2017-142 and A-2017-290
<br />City of Santa Ana, its officers, employees, agents and representatives are Additional Insureds with respect to General and Auto Liability per the attached
<br />endorsements as required by written contract. Insurance is Primary and Non -Contributory. Waiver of Subrogation applies to Workers' Compensation.
<br />30 Days Notice of Cancellation with 10 Days Notice for Non -Payment of Premium in accordance with the policy r isions.
<br />REVIEWED BY: EUNICE HEREDIA (PG OF L )
<br />City of Santa Ana
<br />20 Civic Center Plaza, M-36
<br />M-36 PO Box 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 />AUTHORIZED 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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