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CERTIFICATE OF LIABILITY INSURANCE <br />/YYYY) <br />DATE (MM/DD(MMIDD9 <br />2 <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 />CONTACT <br />NAME: <br />Dealey, Renton & Associates <br />PHONE FAX <br />P. O. Box 12675 <br />AIC No Ext : 510-465-3090 A/C No): 510-452-2193 <br />ADODRESS: Certificates@Dealeyrenton.com <br />Oakland, CA 94604-2675 <br />INSURER(S) AFFORDING COVERAGE <br />NAIC# <br />License #0020739 <br />INSURERA: Atlantic Specialty Insurance Company <br />27154 <br />INSURED RMAGROUP <br />INSURER B <br />RMA Group, Inc. <br />RMA Group of Northern California, Inc. <br />INsuRERc: <br />12130 Santa Margarita Court <br />INSURER D 7 <br />INSURERE: <br />Rancho Cucamonga, CA 91730 <br />(909) 989-1751 <br />INSURER F <br />COVERAGES CERTIFICATE NUMBER:296614665 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 />POLICY NUMBER <br />POLICY EFF <br />MM/DD/YYYY <br />POLICY EXP <br />MM/DD/YYYY <br />LIMITS <br />COMMERCIAL GENERAL LIABILITY <br />EACH OCCURRENCE <br />$ <br />DAMAGE TO <br />CLAIMS-MADE1:1 OCCUR <br />PREMISES ccurrence <br />PREMISES Ea occurrence) <br />$ <br />MED EXP (Any one person) <br />$ <br />PERSONAL & ADV INJURY <br />$ <br />GEN'L <br />AGGREGATE LIMIT APPLIES PER: <br />GENERAL AGGREGATE <br />$ <br />POLICY ❑ PRO ❑ LOC <br />JECT <br />PRODUCTS - COMP/OP AGG <br />$ <br />$ <br />OTHER: <br />AUTOMOBILE <br />LIABILITY <br />COMBINED SINGLE LIMIT <br />Ea accident <br />$ <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 />HIRED 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 />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY Y / N <br />PER OTH- <br />STATUTE ER <br />ANYPROPRIETOR/PARTNER/EXECUTIVE <br />E.L. EACH ACCIDENT <br />$ <br />OFFICER/MEMBER EXCLUDED? ❑ <br />NIA <br />E.L. DISEASE - EA EMPLOYEE <br />$ <br />(Mandatory in NH) <br />If yes, describe under <br />DESCRIPTION OF OPERATIONS below <br />E.L. DISEASE - POLICY LIMIT <br />$ <br />A <br />Professional Liability <br />DPL720817 <br />10/1/2018 <br />10/1/2019 <br />$1,000,000 <br />per Claim <br />Claims Made <br />$1,000,000 <br />Annual Aggregate <br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) <br />Project #18-1052-0 / On -Call <br />CERTIFICATE HOLDER CANCELLATION 30 Day 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 />ACCORDANCE WITH THE POLICY PROVISIONS. <br />City of Santa Ana <br />20 Civic Center Plaza <br />AUTHORIZED REPRESENTATIVE <br />Santa Ana CA 92701 <br />ACORD 25 (2016/03) <br />©1988-2015 ACORD CORPORATION. All rights reserved. <br />The ACORD name and logo are registered marks of ACORD <br />