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Tori Pierson
<br />Tori Piersonoe�4'o, ns.aa ovp3nsar00'
<br />GILL&PA-01
<br />HAVARE
<br />DgTE18/17/20210/2
<br />,a►��Ro CERTIFICATE OF LIABILITY INSURANCE
<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 Erica Wilson
<br />NA E:
<br />IDA Insurance Services
<br />4370 La Jolla Village Drive
<br />Suite 600
<br />San Diego, CA 92122
<br />PHONE
<br />Alc, NP, Eat):
<br />FAX
<br />(858) 754-0063 50233 A/C, No):(619) 574-6288
<br />kb%A,'Ess. Erica.Wilson@ioausa.com
<br />INSURERS AFFORDING COVERAGE
<br />NAIC M
<br />INSURER A: RLI Insurance Company
<br />13056
<br />INSURED
<br />INSURER B: Hudson Insurance Company
<br />25054
<br />INSURER C:
<br />Gillis & Panichapan Architects, Incorporated
<br />INSURER D :
<br />2900 Bristol St. Suite G205
<br />Costa Mesa, CA 92626
<br />INSURER E :
<br />N.URERF:
<br />COVERAGES CERRFVISION 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 CONTRACTOROTHER DOCUMENTWITH 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 />INBR
<br />LTR
<br />TYPE OF INSURANCE
<br />AOOL
<br />D
<br />BURR
<br />D
<br />POLICY NUMBER
<br />POLICY EFF
<br />POLICY EXP
<br />DD
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />CI -AIMS -MADE X OCCUR
<br />X
<br />PSB0001119
<br />9/112021
<br />9/1/2022
<br />EACH OCCURRENCE
<br />$ 2,000,000
<br />DAMAGE TO RENTED
<br />EMISES Ea occurrence
<br />11000,000
<br />X
<br />MED EXP (My oneperson)
<br />10,000
<br />Contractual Llab.
<br />Sev of Interests
<br />PERSONAL &ADV INJURY
<br />2,000,000
<br />X
<br />GEN'L
<br />AGGREGATE LIMIT APPLIES PER:
<br />POLICY [:] YReT 11 LOG
<br />GENERALAGGREGATE
<br />1 4,000,000
<br />PRODUCTS - COMPIOP AGO
<br />1 4,000,000
<br />'.Deductible
<br />$ 0
<br />OTHER:
<br />A
<br />AUTOMOBILE
<br />LIABILITY
<br />Fa E.INEDtdyinSINGLELIMIT
<br />$ 1,000,000
<br />X
<br />ANY AUTO
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOSS
<br />PSA0001116
<br />9/112021
<br />9/1/2022 BODILY INJURY Per Person)$
<br />BODILY INJURY Per accident
<br />$
<br />$
<br />Ai)T030NLV AUTOS ONFV
<br />Comp.:$1.000 X CCIL$1,000
<br />Fe�accident AMAGE
<br />X
<br />A
<br />UMBRELLA LIAR
<br />OCCUR
<br />EACH OCCURRENCE
<br />$ 3,000,000
<br />X
<br />X
<br />$ 3,000,000
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />PSE0001038
<br />91112021
<br />9/1/2022 AGGREGATE
<br />DED X RETENTION$ 0
<br />It
<br />A
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY YIN
<br />ANYPROPRIETORIPARTNER/E%ECDTIVE
<br />pFFICERIMEMBEpp EXCLUDED? ❑
<br />(Mandatorym NH)
<br />R yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />NIA
<br />PSW0001177
<br />911/2021
<br />PER OTH-
<br />X ER
<br />9/1/2022 EL EACH ACCIDENT
<br />ELDISEASE-EAEMPLDYE
<br />EL DISEASE -POLICY LIMIT
<br />1,000,000
<br />1,000,000
<br />1,000,000
<br />B
<br />Prof LiablClms Made
<br />PRB0619110942
<br />1118/2020
<br />11/812021 Per Claim
<br />2,000,000
<br />B
<br />Ded.: $5k Per Claim
<br />PRB0619110942
<br />111812020
<br />11/812021 Aggregate
<br />2,000,000
<br />DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
<br />Re: All Operations
<br />The City of Santa Ana is Additional Insured with respect to General Liability per the attached endorsement as required by written contract.
<br />30 Days Notice of Cancellation with 10 Days Notice for Non -Payment of Premium in accordance with the policy provisions.
<br />City of Santa Ana
<br />Risk Management Division
<br />20 Civic Center Plaza, 4th Floor
<br />ACORD 25 (2016103)
<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 PROV'-""'
<br />Risk Muugenrnt of.
<br />AUTHORIZED REPRESENTATIVE RENEwm6APPgso,,E v:
<br />T AJELL , 4d� M 7. P,, .r
<br />Rbx,Managemmr oniralnar
<br />91988.2015 ACORD C(
<br />The ACORD name and logo are registered marks of ACORD
<br />
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