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Francine R. Dlglta l ly signed by Francine R.
<br />V11 area]
<br />Villareal Date: 2021.04.lslo:a817-o7'00'
<br />WOOLINC-01 KGODWIN
<br />CERTIFICATE OF LIABILITY INSURANCE
<br />DATE(MM/DD/YYYY)
<br />4/6/2021
<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 />CONTACT
<br />NAME:
<br />PHONE
<br />(A/C, No, Ext): (703) 827-2277 FAX No): (703) 827-2279
<br />Ames & Gough
<br />8300 Greensboro Drive
<br />Suite 980
<br />E-MAIL-ADDRESS: admin@amesgough.com
<br />McLean, VA 22102
<br />INSURER S AFFORDING COVERAGE
<br />NAIC #
<br />INSURER A: Travelers Indemnity Co. of America A++ XV
<br />25666
<br />INSURED
<br />INSURERB: Phoenix Insurance Company A++ XV
<br />25623
<br />INSURER C : Travelers Property Casualty Company of America
<br />25674
<br />Woolpert Inc.
<br />INSURERD: National Union Fire Insurance Company
<br />19445
<br />4454Idea Center Boulevard
<br />Dayton, OH 45430-1500
<br />INSURERE: Continental Casualty Company CNA) A XV
<br />20443
<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 />MWDD/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 i OCCUR
<br />P6309P881661
<br />3/1/2021
<br />3/1/2022
<br />DAMAGE TO RENTED
<br />PREMISES Ea occurrence
<br />1,000,000
<br />$
<br />MED EXP (Any oneperson)
<br />$ 10,000
<br />PERSONAL & ADV INJURY
<br />$ 1,000,000
<br />GEN'L
<br />AGGREGATE LIMIT APPLIES PER:
<br />GENERAL AGGREGATE
<br />$ 2,000,000
<br />POLICY X71 JECT El LOC
<br />PRODUCTS - COMP/OPAGG
<br />$ 2,000,000
<br />$
<br />OTHER:
<br />B
<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 />8109P88164821
<br />3/1/2021
<br />3/1/2022
<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 />C
<br />X
<br />UMBRELLA LIAB
<br />X
<br />OCCUR
<br />EACH OCCURRENCE
<br />$ 10,000,000
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />ZUP-31NIO602-21-NF
<br />3/1/2021
<br />3/1/2022
<br />AGGREGATE
<br />$ 10,000,000
<br />DED X RETENTION $ 0
<br />$
<br />D
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY
<br />Y/N
<br />ANY PROPRIETOR/PARTNER/EXECUTIVE
<br />11326673
<br />3/1/2021
<br />3/1/2022
<br />X PER OTH-
<br />STATUTE ER
<br />E.L. EACH ACCIDENT
<br />1,000,000
<br />$
<br />OFFICER/MEMBER EXCLUDED? ❑
<br />(Mandatory in NH)
<br />N/A
<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 />E
<br />Professional Liab.
<br />:E7
<br />8355072
<br />3/1/2021
<br />3/1/2022
<br />Per Claim/Aggregate
<br />2,000,000
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
<br />RE: PROJ #78392 — RFP #17-101
<br />The City of Santa Ana, its officers, employees, agents, volunteers and representatives are included as additional insured with respect to General Liability
<br />when required by written contract. General Liability includes Additional Insured coverage for On -Going & Completed Operations as required by written
<br />contract. General Liability is primary and non-contributory over any existing insurance and limited to liability arising out of the operations of the named
<br />insured and when required by written contract. 30-day Notice of Cancellation will be issued for the General Liability, Automobile Liability, Umbrella Liability,
<br />Workers Compensation and Professional Liability policies in accordance with policy terms and conditions.
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />City of Santa Ana
<br />ty
<br />THE EXPIRATION DATE THEREOF,
<br />NOTICE WILL BE DELIVERED IN
<br />Risk Management Division, 4th Floor
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />20 Civic Center Plaza
<br />Santa Ana, CA 92702
<br />AUTHORIZED REPRESENTATIVE
<br />RisieMatlagementDiviaian
<br />REVIEWED & APPROVED BY.-
<br />/
<br />z
<br />ACORD 25 (2016/03)
<br />© 1988-2015 ACORD CII
<br />The ACORD name and logo are registered marks of ACORD
<br />Risk Management Analyst
<br />
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