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ACORO®DATE
<br />CERTIFICATE OF LIABILITY INSURANCE
<br />(MM/DD/YYYY)
<br />12/31/2018
<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 />CONTACT
<br />NAME: Certificate Department
<br />PHONE FAX
<br />A/c No Extl: 619-744-0574 vc No): 619-234-8601
<br />San Diego CA 92101
<br />ADMDRESS, certificates@cavignac.com
<br />INSURERS AFFORDING COVERAGE
<br />NAIC #
<br />6076046485
<br />INSURER A: XL Specialty Company
<br />37885
<br />I��
<br />EACH OCCURRENCE $ 1,000,000
<br />INSURED RICKENG-01
<br />Rick Engineering Company
<br />5620 Friars Road
<br />INSURER B: Valle Fore Insurance Company 20508
<br />INSURER C: Continental Casualt Co. 20443
<br />INSURER D; Amer Cas. Co of Reading, PA
<br />San Diego, CA 92110
<br />INSURER E:
<br />INSURER F:
<br />COVERAGES CERTIFICATE NUMBER: 969813678 REVISION NIIMRER-
<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 />I
<br />LTR
<br />TYPE OF INSURANCE
<br />IVSD
<br />WVD SUER
<br />POLICY NUMBER
<br />MM DDPOLICY EFF
<br />EXP
<br />MM OLIDDY
<br />LIMITS
<br />B
<br />X j COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE a OCCUR
<br />Y
<br />6076046485
<br />1/1/2019
<br />1/1/2020
<br />EACH OCCURRENCE $ 1,000,000
<br />DAMAGE O RENTED
<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 $200000 .,0
<br />X POLICYFX JECT � LOC
<br />PRODUCTS - COMP/OP AGG $ 2,000,000
<br />Deductible I $ 0
<br />OTHER:
<br />C
<br />AUTOMOBILE LIABILITY
<br />6076046499
<br />1/1/2019
<br />1!1/2020
<br />COMBINED SINGLE LIMIT $1,000,000 Ea accident) 1 000 000
<br />BODILY INJURY (Per person) $
<br />ANY AUTO
<br />ALL OWNEDSCHEDULED
<br />!AUTOS AUTOS
<br />BODILY INJURY (Per accident) $
<br />NON -OWNED
<br />Y` HIRED AUTOS X AUTOS
<br />PROPERTY DAMAGE $
<br />Per accident
<br />UMBRELLA LIAB
<br />OCCUR
<br />EACH OCCURRENCE $
<br />AGGREGATE $
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />I
<br />DED RETENTION $
<br />$
<br />D
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY Y / N
<br />6076046521
<br />1/1/2019
<br />1/1/2020
<br />XPER OTH-
<br />STATUTE ER
<br />E.L. EACH ACCIDENT $ 1,000,000
<br />ANY PROPRIETOR/PARTNER/EXECUTIVE ❑N
<br />OFFICER/MEMBER EXCLUDED?
<br />/ A
<br />E.L. DISEASE - EA EMPLOYEE $ 1,000,000
<br />(Mandatory in NH)
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE - POLICY LIMIT $ 1,000,000
<br />A
<br />Professional Liability
<br />DPR9930428
<br />8/15/2018
<br />8/15/2019
<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 per policy form.
<br />Primary coverage applies to General Liability per policy form. Prof. Liab. - Claims made, defense costs included within limit. If the insurance company elects to
<br />cancel or non -renew coverage for any reason other than nonpayment of premium Cavignac & Associates will provide 30 days notice of such cancellation or
<br />nonrenewal.
<br />REVIEWED BY: EUNICE HEREDIA (PG OF W2
<br />L,r_m I Iri,_m I C nULUCI[
<br />City of Santa Ana
<br />20 Civic Center Plaza M-36
<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 />AUTHORIZED REPRESENTATIVE
<br />1
<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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