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Samantha M. Digitally signed by Samantha M.
<br />Lambert
<br />I �mhorl
<br />i �..���....��� .,,....._.,_,..,.,._, ,,.�...,, .,,.,.,
<br />A� " CERTIFICATE OF LIABILITY INSURANCE
<br />DATE(MM/DD/YYYY)
<br />8/18/2021
<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 rights to the certificate holder in lieu of such endorsement(s).
<br />PRODUCER
<br />AssuredPartners Design Professionals Insurance Services, LLC
<br />3697 Mt. Diablo Blvd., Suite 230
<br />CA 94549
<br />CONTACT
<br />NAME: Nancy Ferrlck
<br />PHONE FAX
<br />A/c No Ext : A/C, No):
<br />E-MLafayette
<br />ADDRESS: Nancy.Ferrick@AssuredPartners.com
<br />INSURER(S) AFFORDING COVERAGE
<br />NAIC #
<br />INSURERA: XL Speciality Insurance Company
<br />37885
<br />License#:6003745
<br />INSURED ARCHRES-04
<br />INSURERB: HARTFORD INSURANCE COMPANY
<br />38288
<br />Architectural Resources Group, Inc.
<br />Pier 9, The Embarcadero, Suite 107
<br />INSURERC: The Travelers Indemnity Company of Connecticut
<br />25682
<br />INSURERD:
<br />San Francisco CA 94111
<br />INSURER E
<br />INSURER F :
<br />COVERAGES CERTIFICATE NUMBER: 1541818206 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 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 />INSD
<br />SUBR
<br />WVD
<br />POLICYNUMBER
<br />POLICY EFF
<br />MM/DD
<br />POLICY EXP
<br />MM/DD
<br />LIMITS
<br />C
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />Y
<br />Y
<br />6802H186591
<br />9/1/2021
<br />9/1/2022
<br />EACH OCCURRENCE
<br />$2,000,000
<br />CLAIMS -MADE OCCUR
<br />DAMAGES(RENTED
<br />PREMISES Ea occurrence)
<br />ccurrence)$
<br />1,000,000
<br />X
<br />MED EXP (Any one person)
<br />$ 10,000
<br />Contractual Liab
<br />Included
<br />PERSONAL & ADV INJURY
<br />$ 2,000,000
<br />GEN'L
<br />AGGREGATE LIMIT APPLIES PER:
<br />GENERAL AGGREGATE
<br />$ 4,000,000
<br />POLICY � ECT � LOC
<br />PRODUCTS - COMP/OP AGG
<br />$ 4,000,000
<br />$
<br />OTHER:
<br />C
<br />AUTOMOBILE
<br />LIABILITY
<br />Y
<br />Y
<br />BA1S985277
<br />9/1/2021
<br />9/1/2022
<br />COMBINED SINGLE LIMIT
<br />Ea accident
<br />$1,000,000
<br />BODILY INJURY (Per person)
<br />$
<br />ANY AUTO
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />BODILY INJURY (Per accident)
<br />$
<br />X
<br />PROPERTY DAMAGE
<br />Per accident
<br />$
<br />HIRED X NON -OWNED
<br />AUTOS ONLY AUTOS ONLY
<br />UMBRELLA LAB
<br />OCCUR
<br />EACH OCCURRENCE
<br />$
<br />AGGREGATE
<br />$
<br />EXCESS LAB
<br />CLAIMS -MADE
<br />DED RETENTION $
<br />$
<br />B
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY Y / N
<br />Y
<br />57VVEGLP7625
<br />9/1/2021
<br />9/1/2022
<br />X PER OTH-
<br />STATUTE ER
<br />ANYPROPRIETOR/PARTNER/EXECUTIVE
<br />E.L. EACH ACCIDENT
<br />$ 1,000,000
<br />OFFICER/MEMBER EXCLUDED? ❑
<br />N/A
<br />E.L. DISEASE - EA EMPLOYEE
<br />$ 1,000,000
<br />(Mandatory in NH)
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE - POLICY LIMIT
<br />$ 1,000,000
<br />A
<br />Professional Liability
<br />DPR9982564
<br />8/20/2021
<br />8/20/2022
<br />Per Claim
<br />$2,000,000
<br />& Contractors Pollution Legal
<br />Annual Aggregate
<br />$2,000,000
<br />Liability
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required)
<br />Re: ARG Project #17161, Santa Ana Environmental and Planning Services. The City of Santa Ana, it's officers, employees, agents and representatives are
<br />named as Additional Insured for General and Auto Liability. Insurance is primary and non-contributory and a severability of interest clause applies per policy
<br />form. A Waiver of Subrogation applies to Workers' Compensation. Certificate of Insurance shall provide thirty (30) day prior written notice of cancellation
<br />CERTIFICATE HOLDER CANCELLATION 30 Days Notice of Cancellation
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />City of Santa Ana ACCORDANCE WITH THE POLICY PROVISIONS.
<br />Risk Management Division
<br />20 Civic Center Plaza, 4th Floor AUTHORIZED.REPRESENTATIVE
<br />Santa Ana CA 92701
<br />REVIEWED & APPROVED Br
<br />@ 1988-2015 ACORD C
<br />��
<br />ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD '
<br />�� Risk Management Supervisor
<br />
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