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NICHCON-02 GRAI
<br />CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY)
<br />5/17/2019
<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 endorsements . _
<br />PRODUCER License # OE67768 _RI - Erica Wilson _
<br />IOA Insurance Services PHONE —�
<br />4370 La Jolla Village Drive (AM,No,Ext: 858 754-0063 50233 vc,Nn: Sig) 574-6288
<br />Suite 600 J6,. Erlca.Wilson@lolausa.com
<br />San Diego, CA 92122 IKIRLJRF3091 AFFORDING COVERAGE NAIL N
<br />INSURED
<br />Nichols Consulting Engineers, CHTD
<br />1885 S. Arlington Ave., #111
<br />Reno, NV 89509
<br />F:
<br />Insurance
<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 />ISR TYPE OF INSURANCE ADDL SUER POLICY NUMBER POLICY EFF POLICY EXP LIMITS
<br />MILXM
<br />A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,DDD,DDD
<br />CLAIMS -MADE ❑ OCCUR X PSR0003222 5/17/2019 5/17/2020 TO RENTED 1,000,000
<br />R ISES;(Faoccurrence]„
<br />X Cont Liab/Sev of Int I MED EXP (Anr one oerean) 5 10,000
<br />GEN'L
<br />AGGRE��'.� LIMIT APPLIES PER:
<br />PRO -
<br />I X I PRO-
<br />❑
<br />P}ZQOUCTS-COMP/OPAGt3
<br />2,DDU,UOD
<br />POLICY I •' JECT LOC
<br />Deductible
<br />0
<br />OTHER.
<br />A
<br />COMBINED SINGLE LIMIT
<br />1,000,000
<br />AUTOMOBILE
<br />LIABILITYfl
<br />$
<br />X
<br />$
<br />ANY AUTO
<br />X
<br />PSAGOO1184
<br />5/17/2019
<br />5/17/2020
<br />BODILY INJURY, ar own
<br />BODILY INJURY(Paracclda t
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />P.ROP�EcIRdTe'lnIpAMAGE
<br />DD
<br />AUTOS AU7�TULY'
<br />rx
<br />ONLY
<br />Comp.: $500 Coll.: $500
<br />X
<br />A
<br />UMBRELLA LIAB
<br />X
<br />OCCUR
<br />r
<br />EACH OCCURRENCE
<br />$
<br />5,000,000
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />IP$E0003030
<br />5/17/2019
<br />5/17/2020
<br />X
<br />&GGREGATE
<br />5,000,000
<br />DED X RETENTION$i
<br />f
<br />A WORKERS COMPENSATION
<br />X PER O7H-
<br />AND EMPLOYERS' LIABILITY Y / N pSWfl©01955
<br />ANY PROPRIETOR/PARTNER/EXECUTIVE X
<br />5/17/2019 5/17/2020 1
<br />_E.Iw -E,&CH ACC [DENT
<br />1,000,000
<br />OFFICER/MEMBER EXCLUDED? N/A
<br />(Mandatory In NH)
<br />E.L..I715Fr49E -EA E PLO EE
<br />1,000,000
<br />It s, descrliLm sander
<br />DESCRIPTION OF OPERATIONS below
<br />E1. DISEASE -POLICY LIMIT
<br />1,000,000
<br />B Prof LiablCims Made PKC108625
<br />51i7120'9 511712020 Per Claim
<br />2,000,000
<br />B Ded.: $10k Per Claim PKC108625
<br />5/17/2019 5/17/2020 Aggregate
<br />2,000,000
<br />DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
<br />Re: Agreement Nos. A-2017-172 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 1 Days Notice for Non -Payment of Premium in accordance with the policy provisions.
<br />REV WED BY:
<br />CERTIFICATE HOLDER
<br />CANCELLATION
<br />RIsIC Manhigem nt Ol 51Ori
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED
<br />IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />` City of Santa Ana I AUTHORIZED REPRESENTATIVE
<br />M-36 PO Box 1988
<br />]Santa Ana. CA 927Q7
<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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