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Client#: 25320
<br />Digitally signed by Francine R.
<br />Francine R. Villareal Villareal
<br />KIMLHORN Date: 2021.05.1215R0:51-07'00'
<br />ACORD.,,, CERTIFICATE OF LIABILITY INSURANCE
<br />DATE (MM/DD/YYYY)
<br />5/12/2021
<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 any rights to the certificate holder in lieu of such endorsement(s).
<br />PRODUCER
<br />Greyling Ins. Brokerage/EPIC
<br />3780 Mansell Road, Suite 370
<br />CONTACT
<br />Jerry Noyola
<br />HON o, Ext : 770-220-7699 FAX No):
<br />E-MAIL no ola re Iln
<br />ADDRESS:er rY• @9 Y • g•tom Y
<br />Alpharetta, GA 30022
<br />INSURER(S) AFFORDING COVERAGE
<br />NAIC #
<br />INSURER A: National Union Fire Ins. Co.
<br />19445
<br />INSURED
<br />Kimley-Horn and Associates, Inc.
<br />421 Fayetteville Street, Suite 600
<br />Raleigh, NC 27601
<br />INSURER B : Allied World Assurance Company (U.S.)
<br />19489
<br />INSURER c :New Hampshire Ins. Co.
<br />23841
<br />INSURER D : Lloyds of London
<br />085202
<br />INSURER E
<br />INSURER F :
<br />COVERAGES CERTIFICATE NUMBER: 21-22 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 CONTRACTOR 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
<br />LTR
<br />TYPE OF INSURANCE
<br />ADDL
<br />INSR
<br />SUBR
<br />WVD
<br />POLICY NUMBER
<br />POLICY EFF
<br />MM/DD/YYYY
<br />POLICY EXP
<br />MM/DD/YYYY
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />GL5268169
<br />4/01/2021
<br />04101/2022
<br />EACH OCCURRENCE
<br />$1,000,000
<br />CLAIMS -MADE L* OCCUR
<br />PREMISESOEaoceu ante
<br />$500,000
<br />X
<br />MED EXP (Any one person)
<br />$ 25,000
<br />Contractual Liab
<br />PERSONAL & ADV INJURY
<br />$1,000,000
<br />GEN'L
<br />AGGREGATE LIMIT APPLIES PER:
<br />GENERAL AGGREGATE
<br />$2,000,000
<br />POLICY ^I JECTPRO- X LOC
<br />PRODUCTS - COMP/OPAGG
<br />$2,000,000
<br />$
<br />OTHER:
<br />A
<br />AUTOMOBILE
<br />LIABILITY
<br />CA4489663
<br />04/01/2021
<br />04/01/202
<br />COEaMBINED accidentSINGLE LIMIT
<br />$2,000,000
<br />X
<br />BODILY INJURY (Per person)
<br />$
<br />ANY AUTO
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />BODILY INJURY (Per accident)
<br />$
<br />PROPERTY DAMAGE
<br />Per accident
<br />$
<br />X
<br />HIRED NON -OWNED
<br />AUTOS ONLY X AUTOS ONLY
<br />B
<br />X
<br />UMBRELLA LIAB
<br />X
<br />OCCUR
<br />03127930
<br />4/01/2021
<br />04/0112022
<br />EACH OCCURRENCE
<br />$5 000 000
<br />AGGREGATE
<br />$5 00O 000
<br />X
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />DED I X RETENTION $1 O 000
<br />$
<br />C
<br />A
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY
<br />ANY PROPRIETOR/PARTNER/EXECUTIVE
<br />OFFICER/MEMBER EXCLUDED? L N
<br />(Mandatory in NH)
<br />N / A
<br />WC015893685 AOS
<br />( )
<br />WC015893686 (CA)
<br />04/01/2021
<br />04/01/2021
<br />04/01/202
<br />04/01/2022
<br />X PER OTH-
<br />STATUTE ER
<br />E.L. EACH ACCIDENT
<br />$1,000,000
<br />E.L. DISEASE - EA EMPLOYEE
<br />$1,000,000
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE - POLICY LIMIT
<br />$1,000,000
<br />D
<br />Professional Liab
<br />B0146LDUSA2104949
<br />04/01/2021
<br />04/01/2022
<br />Per Claim $2,000,000
<br />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: City of Santa Ana Agreement A-2018-160-01. The City of Santa Ana, its officers, employees, agents &
<br />representatives are named as Additional Insureds with respects to General & Automobile Liability where
<br />required by written contract. The above referenced liability policies with the exception of workers
<br />compensation & professional liability are primary & non-contributory where required by written contract.
<br />Separation of Insureds applies to the General Liability Policy. Umbrella Follows Form with respects to
<br />(See Attached Descriptions)
<br />CERTIFICATE HOLDER CANCELLATION
<br />City of Santa Ana
<br />Risk Management Division
<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 />20 Civic Center Plaza, 4th Floor
<br />Santa Ana, CA 92702-0000 AUTHORIZED REPRESENTATIVE
<br />© 1988-2015 ACORD
<br />ACORD 25 (2016/03) 1 of 2 The ACORD name and logo are registered marks of ACORD
<br />#S2724085/M2660308
<br />�oRaN RiskManagmentDMsian
<br />REVIEWED & APPROVED BY.
<br />3 r
<br />Risk Management Analyst
<br />
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