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CERTIFICATE OF LIABILITY INSURANCE
<br />DATE(MM/DDIYYYY)
<br />7/25/2019
<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
<br />CONTACT
<br />NAME:
<br />Dealey, Renton & Associates
<br />PHONE FAX
<br />790 E Colorado Blvd #460
<br />510 465-3090 No
<br />EArL
<br />ADDRESS: certificates Beale renton,com
<br />Pasadena, CA 91101
<br />INSURER ($) AFFORDING COVERAGE
<br />NAIC #
<br />License #0020739
<br />INSURER A: Travelers Property Casualty Co of Ameri
<br />25674
<br />INSURED KOACORPOR
<br />INSURERS: XL Specialty Insurance Co.
<br />37885
<br />KOA Corporation
<br />1100 Corporate Center Drive #201
<br />INSURERC:
<br />INSURER D_:
<br />Monterey Park, CA 91754
<br />(323) 260-4703
<br />INSURER E:
<br />INSURER F :
<br />COVERAGES CERTIFICATE NUMBER:1495438135 REVISION NUMBER:
<br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
<br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />INLTR SR
<br />I TYPE OF INSURANCE
<br />ADnLSUXP
<br />1=_WVD
<br />R
<br />POLICY NUMBER
<br />PO DDY EYYY FF
<br />PM/DD OLICY EYYY
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />Y
<br />Y
<br />680811966428
<br />3/13/2019
<br />3/13/2020
<br />EACH OCCURRENCE
<br />$ 2 000 000
<br />CLAIMS -MADE n OCCUR
<br />RM.ISES Eaoccurrencel
<br />$1,000,000
<br />X
<br />$ 10,000
<br />Contractual Liab
<br />MED EXP (Any oneperson)
<br />X XCU Included
<br />PERSONAL & ADV INJURY
<br />$ 2,000.000
<br />GENERAL AGGREGATE
<br />$ 4,000.000
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />POLICY A I PRO JECT ❑ LOC
<br />PRODUCTS - COMP/OP AGG
<br />$ 4,000,000
<br />$
<br />OTHER:
<br />A
<br />AUTOMOBILE
<br />LIABILITY
<br />Y
<br />Y
<br />BA2A439568
<br />3/13/2019
<br />3/13/2020
<br />OM1 . 1 MI
<br />Ea ocidenl
<br />$ 1,000,000
<br />BODILY INJURY (Per person)
<br />$
<br />ANY AUTO
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />IX
<br />BODILY INJURY (Per accident)
<br />$
<br />X
<br />PROPERTY DAMAGE
<br />tPer Oc_ k Ona) _ _
<br />$
<br />HIRED X NON -OWNED
<br />AUTOS ONLY AUTOS ONLY
<br />I
<br />I
<br />A
<br />X
<br />UMBRELLA LIAB X
<br />OCCUR
<br />CUP6464YO33
<br />3/13/2019
<br />3/13/2020
<br />EACH OCCURRENCE
<br />$ 5,000,000
<br />AGGREGATE
<br />$ 5,000,000
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />DED I X I RETENTION $ n
<br />$
<br />I
<br />A
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY IN
<br />ANYPROPRIETOR/PARTNER/EXECUTIVE YNIA
<br />Y
<br />UB21_459350
<br />9/19/2018
<br />9/19/2019
<br />X PER
<br />I STATUTE
<br />E.L. EACH ACCIDENT
<br />$ 1,000,000
<br />OFFICER/MEMBEREXCLUDED7
<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 />B
<br />Professional Liability
<br />DPR9938453
<br />3/13/2019
<br />3/13/2020
<br />$2.000,000
<br />per Claim
<br />$2,000,000
<br />Annual Aggregate
<br />Pollution Liability Included
<br />DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
<br />AM Best's Rating on all policies above: AIXII or greater. Umbrella Llabillty policy is follow -form to its underlying Policies: General Liability/Auto
<br />Liability/Employers Liability,
<br />Re: Job Number J13&3138 — Santa Ana Bush St Bicycle. Blvd Deslgn
<br />City of Santa Ana, its officers, empployees, agents, volunteers and representatives are Additional Insured as respects to General Liability coverage as required
<br />by written Contract. Primary and Non•Cantributoy as required by written contract.
<br />SEVERABILI'TY OF INTERESTS
<br />Separation of Insureds - Except with respect to the Limits of Insurance, and any rights or duties specifically assigned in this Coverage Part to the first Named
<br />Insured, this insurance applies:
<br />See Attached...
<br />LLri I Ir'IL.HI t nVLUrM _ _ _ _ - - - -- VAIV4tLLA I IUN .7U uav iVOiice oT k anceiiauon
<br />By RISk MANAGEMENT Div 15 OPfHOULD 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 C 02 2019
<br />20 Civic Center Plaza AUTHORIIEDRrPPR,EES£NTATiVE
<br />Santa Ana CA 92702
<br />ERANCINE R. VILLARE
<br />©1988-2015 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
<br />
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