|
NEWCAND-01
<br />A- 2a ig - n5�'
<br />SIMMST
<br />,4cof20" CERTIFICATE OF LIABILITY INSURANCE
<br />`-�
<br />DATE(MMIDD YY)
<br />5/1/2018
<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 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 />CONTE ncr Michelle Costa
<br />IDA Insurance Services
<br />3875 Hopyard Road
<br />Suite 240
<br />PHONE FAX
<br />(A/C, No, E.t): (925) 660-3508 50028 AIC, N.):(925) 416-7869
<br />EbMILSS, Michelle.Costa@ioausa.com
<br />Pleasanton, CA 94588
<br />INSURER 5 AFFORDING COVERAGE NAIC M
<br />INSURER A:RLI Insurance Company 13056
<br />DAMAGE TO RENTED 1,000,000
<br />PREMISES Me occummo. $
<br />INSURED
<br />INSURER B
<br />INSURER C
<br />Newcomb Anderson McCormick, Inc.
<br />INSURER D:
<br />201 Mission Street, Suite 2000
<br />San Francisco, CA 94105
<br />INSURER E
<br />INSURER F
<br />AUTOMOBILE LIABILITY
<br />ANYAUTO
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />X AUTOS ONLY X AUTOS ONLY
<br />COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
<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 DOCUMENTWITH RESPECTTO WHICH THIS
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECTTO ALLTHETERMS,
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />INSRTYPE
<br />OF INSURANCE
<br />ADDL
<br />SUBR
<br />POLICY NUMBER
<br />POLICY EFF
<br />POLICY EXP
<br />LIMITS
<br />A
<br />X COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE �X OCCUR
<br />PSB0001566
<br />05/20/2017
<br />05/20/2018
<br />EACH OCCURRENCE $ 2.000,000
<br />DAMAGE TO RENTED 1,000,000
<br />PREMISES Me occummo. $
<br />MED EXP (My one erson $ 10,000
<br />PERSONAL& ADV INJURY $ 2,000,000
<br />GENL AGGREGATE LIMIT APPLIES PER:
<br />POUCYEX JELOT E LOC
<br />OTHER:
<br />GENERALAGGREGATE $ 4,000,000
<br />PRODUCTS - COMP/OP AGG $ 4,000,000
<br />A
<br />AUTOMOBILE LIABILITY
<br />ANYAUTO
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />X AUTOS ONLY X AUTOS ONLY
<br />PSB0001566
<br />05/20/2017
<br />05/2012018
<br />COMBINED SINGLE LIMIT 2,000,000
<br />Me accident $
<br />BODILY INJURY Per erson
<br />BODILY INJURY Per accident $
<br />Pe�aciitlent AMAGE $
<br />A
<br />X
<br />UMBRELLA LIAB
<br />EXCESS LIAB
<br />X
<br />OCCUREACH
<br />CLAIMS -MADE
<br />PSE0001362
<br />05/2012017
<br />05120/2018
<br />OCCURRENCE $ 1.000,000
<br />AGGREGATE $ 1,000,000
<br />DED I I RETENTION$
<br />A
<br />WORKERS COMPENSATION
<br />AND EMPLOVERSLIABILITV YIN
<br />ANY PROPRIETOR/PARTNDED' CUTIVE ❑
<br />p�FICER/MEn NH)E%CLUDED?
<br />(Mandatory in NH)
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />NIA
<br />PSW0001461
<br />051201201705120/2018
<br />X PER
<br />E ERH
<br />E.L. EACH ACCIDENT $ 1,000.,000
<br />E.L. DISEASE - EA EMPLOYE 1,000,000
<br />E.L. DISEASE - POLICY LIMIT 1,000,000
<br />A
<br />A
<br />Professional Liab.
<br />Professional Liab.
<br />RDP0028931
<br />RDP0028931
<br />05/20/2017
<br />0512012017
<br />0512012018
<br />0512012018
<br />Per Claim 1,000,000
<br />Aggregate 2,000,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required)
<br />All operations of the Named Insured.
<br />General Liability: City of Santa Ana is included as Additional Insured on Primary & Non -Contributory basis as required by written contract.
<br />City of Santa Ana
<br />20 Civic Center Plaza (M-30)
<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 />"
<br />ACORD 25 (2016/03) ©1988.2015 ACORD CORPORATION. All rights reserved.
<br />The
<br />The ACORD name and logo are registered marks of ACORD
<br />FAF
<br />✓
<br />
|