|
Digit
<br />signed by To ri Pirson
<br />Tori Pierson Datea21021.120815:08:23e08'00'
<br />FEHR&PE-01 MICHAELA
<br />ACORO"° CERTIFICATE OF LIABILITY INSURANCE
<br />`64�
<br />DATE(MM/DD/YYYY)
<br />11 /24/2021
<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 License # OE67768
<br />CONTACT Glgl Yuen
<br />PHONE FAX
<br />(A/C, No, Ext): (925) 660-3514 50008 (A/C, No): (925) 416-7869
<br />IOA Insurance Services
<br />3875 Ho yard Road
<br />Suite 20
<br />E-MAIL Gigi.Yuen@ioausa.com
<br />Gi Yuen^
<br />ADDRESS: g
<br />Pleasanton, CA 94588
<br />INSURERS AFFORDING COVERAGE
<br />NAIC #
<br />INSURERA: RLI Insurance Company
<br />13056
<br />INSURED
<br />INSURERB: Hartford Casualty Insurance Company
<br />29424
<br />INSURERC: Liberty Surplus Insurance Corp10725
<br />Fehr & Peers
<br />INSURER D :
<br />100 Pringle Avenue, Suite 600
<br />Walnut Creek, CA 94596
<br />INSURER E
<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 />MMIDD/YYYY
<br />POLICY EXP
<br />MMIDD/YYYY
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />EACH OCCURRENCE
<br />$ 2,000,000
<br />CLAIMS -MADE j OCCUR
<br />PSB0006683
<br />12/6/2021
<br />12/6/2022
<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 />$ 2,000,000
<br />GEN'L
<br />AGGREGATE LIMIT APPLIES PER:
<br />GENERAL AGGREGATE
<br />$ 4,000,000
<br />POLICY X71 JECT El LOC
<br />PRODUCTS - COMP/OPAGG
<br />$ 4,000,000
<br />$
<br />OTHER:
<br />A
<br />AUTOMOBILE
<br />LIABILITY
<br />COMBINED SINGLE LIMIT
<br />Ea accident
<br />1,000,000
<br />$
<br />BODILY INJURY Perperson)
<br />$
<br />ANY AUTO
<br />PSA0002276
<br />12/6/2021
<br />12/6/2022
<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 />A
<br />UMBRELLA LIAB
<br />X
<br />OCCUR
<br />EACH OCCURRENCE
<br />$ 5,000,000
<br />X
<br />EXCESS LAB
<br />CLAIMS -MADE
<br />PSE0002889
<br />12/6/2021
<br />12/6/2022
<br />AGGREGATE
<br />$ 5,000,000
<br />DED RETENTION $
<br />$
<br />B
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY
<br />Y/N
<br />ANY PROPRIETOR/PARTNER/EXECUTIVE ❑
<br />OFFICER/MEMBER EXCLUDED?
<br />(Mandatory in NH)
<br />N/A
<br />57WEGZJ1989
<br />5/1/2021
<br />5/1/2022
<br />X PER OTH-
<br />STATUTE ER
<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 />AEXNYABEFJ2006
<br />12/6/2021
<br />12/6/2022
<br />Per Claim
<br />5,000,000
<br />C
<br />Professional Liab.
<br />AEXNYABEFJ2006
<br />12/6/2021
<br />12/6/2022
<br />Aggregate
<br />5,000,000
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
<br />P19-1593 Santa Ana On -Call VMT - OC20-0710.00, OC20-0710.01 & OC19STAN.00
<br />All Operations of the Named Insured, including the aforementioned project, if any.
<br />General Liability: Please see blanket Additional Insured endorsement attached; such coverage is Primary and Non -Contributory, as required per written
<br />contract.
<br />Auto Liability: No company owned vehicles. Please see blanket Additional Insured endorsement, as required per written contract.
<br />GENERAL LIABILITY & AUTO LIABILITY INCLUDE THE FOLLOWING PERSON(S) OR ORGANIZATION IS): The City of Santa Ana, its officers, employees,
<br />agents and representatives, as required per written contract
<br />30-Day Notice of Cancellation is included per policy provisions.
<br />City of Santa Ana
<br />Risk Management Division
<br />20 Civic Center Plaza
<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 PROM——
<br />AUTHORIZED REPRESENTATIVE {,f & APW{rxt7M1 ED BYr
<br />"• "; Rrsl<M�areagenxsi40-calAsdie
<br />ACORD 25 (2016/03) © 1988-2015 ACORD C( 6 '"g
<br />The ACORD name and logo are registered marks of ACORD
<br />
|