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A�ORO
<br />Digitally signed by Francine R.
<br />Francine R. Villareal Villareal
<br />Date: 2021.07.07 15*39:53-07'00'
<br />VCACONS-01 MCGRAWM
<br />D/YYYY)
<br />E (MM/D
<br />CERTIFICATE OF LIABILITY INSURANCE DATE
<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 License # OE67768
<br />CONTACT Ali Smith
<br />NAME:
<br />PHONE FAX
<br />(A/C, No, Ext): (619) 788-5795 50206 (A/C, No):(619) 574-6288
<br />IOA Insurance Services
<br />4370 La Jolla Village Drive
<br />Suite 600
<br />E-MAIL-ADDRESS: Ali.Smith@ioausa.com
<br />San Diego, CA 92122
<br />INSURERS AFFORDING COVERAGE
<br />NAIC #
<br />INSURER A : Travelers Property Casualty Company of America
<br />25674
<br />INSURED
<br />INSURER B : Hartford Fire Insurance Company
<br />19682
<br />VCA Consultants, Inc.
<br />INSURER C: Interstate Fire & Casualty Company
<br />22829
<br />(See Desc. of Operations for Full Named Insured)
<br />1845 W. Orangewood Ave, Suite 200
<br />INSURER D 7
<br />INSURERE:
<br />Orange, CA 92868
<br />INSURER F :
<br />COVERAGES CERTIFICATE NUMBER: 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 />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />CLAIMS -MADE X OCCUR
<br />X
<br />X
<br />6801R291569
<br />7/1/2021
<br />]/1/2022
<br />DAMAGE TO RENTED
<br />PREMISES Ea occurrence
<br />1,000,000
<br />$
<br />X
<br />MED EXP (Any oneperson)
<br />$ 5,000
<br />Cont Liab/Sev of Int
<br />PERSONAL & ADV INJURY
<br />$ 1,000,000
<br />GENT
<br />AGGREGATE LIMIT APPLIES PER:
<br />GENERAL AGGREGATE
<br />$ 2,000,000
<br />POLICY X 71 PEA LOC
<br />PRODUCTS - COMP/OP AGG
<br />$ 2,000,000
<br />Deductible
<br />$ 0
<br />OTHER:
<br />A
<br />AUTOMOBILE
<br />LIABILITY
<br />COMBINED SINGLE LIMIT
<br />Ea accident
<br />1,000,000
<br />$
<br />X
<br />BODILY INJURY Perperson)
<br />$
<br />ANY AUTO
<br />X
<br />BA1R294222
<br />7/1/2021
<br />7/1/2022
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />BODILY INJURY Per accident
<br />$
<br />PROPERTY DAMAGE
<br />Per accident)
<br />ccident
<br />$
<br />HIRED NON -OWNED
<br />AUTOS ONLY AUTOS ONLY
<br />X
<br />Comp.: $1,000 X Coll.: $1,000
<br />A
<br />X
<br />UMBRELLA LIAB
<br />X
<br />OCCUR
<br />EACH OCCURRENCE
<br />$ 5,000,000
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />CUP1R295206
<br />7/1/2021
<br />7/1/2022
<br />AGGREGATE
<br />$ 5,000,000
<br />DED X RETENTION $ 0
<br />$
<br />B
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY
<br />ANY PROPRIETOR/ R/EXECUTIVE ❑
<br />EXCLU
<br />OFFICER/MEMBER EXCLUDED?
<br />(Mandatory in NH)
<br />A
<br />N/A
<br />X
<br />72W EGA M3J XV
<br />7/1/2021
<br />7/1/2022
<br />X PER R
<br />STATUTE EER
<br />E.L. EACH ACCIDENT
<br />1,000,000
<br />$
<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 />$
<br />C
<br />Professional Liab.
<br />USF00847421
<br />7/1/2021
<br />7/1/2022
<br />Per Claim
<br />2,000,000
<br />C
<br />Claims Made
<br />USF00847421
<br />7/1/2021
<br />7/1/2022
<br />Aggregate
<br />4,000,000
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required)
<br />Named Insured Includes: dba VCA Structural; dba VCA Consultants; Van Dorpe Chou Associates, Inc.; The Code Group, Inc.; dba VCA Green; dba VCA Code;
<br />dba VCA Code Group. The Umbrella policy is follow -form to the underlying GL, Auto and WC policies.
<br />Re: Contract Staffing, Plan Check, and Sustainability Services
<br />City of Santa Ana, officers, agents, employees, and volunteers 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 General Liability and Workers'
<br />SEE ATTACHED ACORD 101
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF,
<br />NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />City of Santa Ana
<br />AUTHORIZED REPRESENTATIVE
<br />Risk Management Division
<br />20 Civic Center Plaza_+$'
<br />��^aN a
<br />RiskMwagementDivisiun
<br />REVIEWED&APPROVEDSY:
<br />Santa Ana CA 92702
<br />z'
<br />ACORD 25 (2016/03)
<br />© 1988-2015 ACORD C.
<br />The ACORD name and logo are registered marks of ACORD
<br />TE�
<br />Risk Management Analyst
<br />
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