|
Digitally signed by Francine R.
<br />Francine R. Villareal Villareal
<br />®
<br />A� oCERTIFICATE OF LIABILITY INSURANCE
<br />DATE (MM/DD/YYYY)
<br />4/29//DDI
<br />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 />Dealey, Renton & Associates
<br />790 E Colorado Blvd #460
<br />CA 91101
<br />CONTACT
<br />NAME: Marie Swaney
<br />PHONE FAX
<br />A/c No EXt A/C, No):
<br />E-MPasadena
<br />ADDRESS: mswaney@dealeyrenton.com
<br />INSURER(S) AFFORDING COVERAGE
<br />NAIC #
<br />INSURERA: Travelers Property Casualty Company of America
<br />25674
<br />License#:0020739
<br />INSURED PROJPAR-01
<br />Project Partners
<br />949 852-9300
<br />INSURER B: The Travelers Indemnity Company of Connecticut
<br />25682
<br />INsuRERc: US Specialty Insurance Company
<br />29599
<br />INSURERD:
<br />23195 La Cadena Drive, Suite 101
<br />Laguna Hills CA 92653
<br />INSURERE:
<br />INSURER F :
<br />COVERAGES CERTIFICATE NUMBER:649868523 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 />B
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />Y
<br />Y
<br />680OJ543236
<br />4/18/2021
<br />4/18/2022
<br />EACH OCCURRENCE
<br />$ 2,000,000
<br />CLAIMS -MADE OCCUR
<br />DAMAGE S(RENTED
<br />PREMISES Ea occurrence)
<br />ccurrence)$
<br />1,000,000
<br />X
<br />VIED EXP (Any one person)
<br />$ 10,000
<br />Contractual Liab
<br />X
<br />XCU 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 PRO-
<br />JECT1:1 LOC
<br />PRODUCTS - COMP/OP AGG
<br />$ 4,000,000
<br />$
<br />OTHER:
<br />B
<br />AUTOMOBILE
<br />LIABILITY
<br />Y
<br />Y
<br />BA6R856630
<br />4/18/2021
<br />4/18/2022
<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 />X
<br />$
<br />NoOwnedAutos
<br />A
<br />X
<br />UMBRELLA LAB
<br />X
<br />OCCUR
<br />Y
<br />Y
<br />CUP8833Y649
<br />4/18/2021
<br />4/18/2022
<br />EACH OCCURRENCE
<br />$1,000,000
<br />AGGREGATE
<br />$ 1,000,000
<br />EXCESS LAB
<br />CLAIMS -MADE
<br />DED X RETENTION $ n
<br />$
<br />A
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY Y / N
<br />Y
<br />UB3J809976
<br />4/18/2021
<br />4/18/2022
<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 />C
<br />Professional Liability
<br />USS2131833
<br />4/18/2021
<br />4/18/2022
<br />Per Claim
<br />$2,000,000
<br />Aggregate Limit
<br />$2,000,000
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required)
<br />Insured owns no company vehicles; therefore, hired/non-owned auto is the maximum coverage that applies. Blanket Wavier of Subrogation applies as required
<br />per written contract. Umbrella policy is follow -form to its underlying Policies: General Liability/Auto Liability/Employers Liability. AM Best's Rating for all policies
<br />listed are: A/XII or greater.
<br />Re: Agreements: A-2018-213, A-2019-117-01, A-2020-153-04 --
<br />The City of Santa Ana, its officers, employees, agents, volunteers and representatives are named as additional insured as respects general and auto liability as
<br />required per written contract or agreement. General Liability is Primary/Non-Contributory per policy form wording. Insurance coverage includes waiver of
<br />subrogation per the attached endorsement(s).
<br />CERTIFICATE HOLDER CANCELLATION 30 Day Notice will be sent to holder
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF,
<br />NOTICE WILL
<br />BE DELIVERED IN
<br />City of Santa Ana
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />Risk Management Division
<br />20 Civic Center Plaza, 4th Floor
<br />AUTHORIZED REPRESENTATIVE
<br />Santa Ana CA 92702
<br />,�oRaN�
<br />Risk MallagementDiviaian
<br />REVIEWED & APPROVED SY:
<br />@ 1988-2015 ACORD C
<br />ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD
<br />'
<br />Risk Management Analyst
<br />
|