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Francine R.
<br />Villareal o,�..roro� voa,,,,moo
<br />ACORbr CERTIFICATE OF LIABILITY INSURANCE
<br />li%./
<br />DATEIMMIDDNYYY)
<br />1 11/13/2020
<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 Aimee Guesno
<br />NAME:
<br />Cornerstone Specialty Insurance SeNlces, Inc.
<br />PHONE (714) 731-7700 FA% (714) 731-7750
<br />AIC No.
<br />o Ext: AIC, No:
<br />14252 Culver Drive, A299
<br />p DD RESS: aimee@cornerstonespecialty.com
<br />INSURER(S) AFFORDING COVERAGE
<br />NAIC#
<br />NIDe CA 92604
<br />INSURER A: Continental Casually Company
<br />20443
<br />INSURED
<br />INSURER B : RLI Insurance Company
<br />13056
<br />CAP Architecture
<br />INSURER C
<br />8700 Warner Avenue
<br />INSURER D :
<br />Suite 280
<br />INSURER E:
<br />Fountain Valley CA 92708
<br />INSURER F:
<br />CUVEKAUES CERTIFICATE NUMBER: RFVISInN NIIMRFR-
<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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
<br />CERTIFICATE MAYBE 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 />AUUL
<br />INSD
<br />NUHK
<br />MD
<br />POLICY NUMBER
<br />POLICY EFF
<br />flMMIDCNYYYI
<br />POLICY EXP
<br />flMMIDDNYVYILIMITS
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE OCCUR
<br />ADDT'L INSURED/PRIMARY
<br />EACH OCCURRENCE
<br />$ 2,000,000
<br />PREMISES Ea occu encs
<br />g 300,000
<br />x
<br />MED EXP(Any one person)
<br />$ 10,000
<br />X1
<br />BLNKTWVROFSUBRO
<br />PERSONAL BADV INJURY
<br />$ 2,000,000
<br />A
<br />Y
<br />5094175320
<br />05/18/2020
<br />05/18/2021
<br />GEN'L AGGREGATE LIMITAPPLIES PER:
<br />POLICY ❑X PRO-
<br />JECT LOG
<br />GENERAL AGGREGATE
<br />$ 4,000,000
<br />PRODUCTS-COMPIOPgGG
<br />3 4,000,000
<br />5
<br />OTHER
<br />I
<br />AUTOMOBILE
<br />LIABILITY
<br />COMINEDSINGLE LIMIT
<br />Ea accitlent
<br />$ 1,000,000
<br />BODILY INJURY (Per person)
<br />S
<br />•OWNEDIANYAUrO
<br />SCHEDULED
<br />AUTOS ONLY AUTOS
<br />5094175320
<br />05/18/2020
<br />05/18/2021
<br />BODILY INJURY Per accident)
<br />$
<br />HIRED NON -OWNED
<br />AUTOS ONLY X AUTOS ONLY
<br />PROPERTYDAGE
<br />MA
<br />Peraccident
<br />$
<br />X
<br />UMBRELLA LIAB
<br />X
<br />OCCUR
<br />EACHOCCURRENCE
<br />$ 1.000,000
<br />A
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />5094854763
<br />05/18/2020
<br />05/18/2021
<br />AGGREGATE
<br />$ 1.000,000
<br />DED I I RETENTION $
<br />'4
<br />WORKERS COMPENSATION
<br />ANDEMPLOYERS'LIABILITY YIN
<br />OFFICEWMEMBER EXGUDED?EClfr1VE ❑
<br />NIA
<br />5094854715
<br />05/18/2020
<br />OS/18/2021
<br />PER OTH-
<br />!C STATUTE ER
<br />E.L. EA CH ACCIDENT
<br />$ 11000,000
<br />E.L. DISEASE- EA EMPLOYEE
<br />$ 11000,000
<br />(Mandatory in NH)
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE -POLICY LIMIT
<br />$ 1100Q000
<br />PROFESSIONAL LIABILITY
<br />EACH CLAIM
<br />$1,000,000
<br />B
<br />Claims Made
<br />RDP0036246
<br />0 //18/2020
<br />05/18/2021
<br />ANNUALAGGREGATE
<br />$2.000,000
<br />DESCRIPTION OF OPERATIONS / LOCATIONS /VEHICLES (ACORD 101, Additional Remarks Schedule, may he allached if more space is required)
<br />RE: RFP 20-040 Space Planning and Architectural Services
<br />The City of Santa Ana, its officers, employees, agents, volunteers and representatives are named Additional Insured for General Liability but only if required
<br />by written contract with the Named Insured poor to an occurrence and as per attached endorsement. Coverage is subject to all policy terms and conditions.
<br />*30 days notice of cancellation, except for 10 days notice for non-payment of premium. For Professional Liability coverage, the aggregate limit is the total
<br />insurance available for all covered claims reported within the policy pence.
<br />City of Santa Ana Risk Management Division
<br />20 Civic Center Plaza, 4th FI
<br />Santa Ana
<br />ACORD 25 (2016103)
<br />CA 92702
<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 />AUTHORIZED REPRESENTATIVE
<br />1988-2015 ACORD
<br />The ACORD name and logo are registered marks of ACORD
<br />Rusk MRwip m ad DilaeMt
<br />c [REVIEWED 6 AP(PR�apv�EDSr�
<br />1 f 4st�MGvi�r �. VrLT. 14tG
<br />1 Risk Management Analyst
<br />
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