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019itally 09md by Tani Pierson
<br />orl Pierson Date: 2021.0 al1521u5-mroo•
<br />.4� o® CERTIFICATE OF LIABILITY INSURANCE
<br />DA (MMIDz1YYY)
<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 />AssuredPartners Design Professionals Insurance Services, LLC
<br />3697 Mt. Diablo Blvd Suite 230
<br />Lafayette CA 94549
<br />CONTACT The Certificate Team
<br />PHONE FAX
<br />ac Not.
<br />E-MAIL CertsDesi nPro AssuredPartnem.com
<br />INSURERS AFFORDING COVERAGE
<br />NAICt
<br />INSURER A: Travelers Property Casualty Company of America
<br />25674
<br />License#: 6003745
<br />INSURED WESTDES-0
<br />Designs, Inc.
<br />949 25-0
<br />949 250-0880
<br />INSURER B: Travelers Casualty and Surety CD of America
<br />31194
<br />INSURER c: The Travelers IndemnityCompany of Connecticut
<br />25682
<br />INSURER D:
<br />19520 Jamboree Rd., Suite 100
<br />Irvine CA 92612
<br />INSURER E :
<br />INSURER F:
<br />COVERAGES CERTIFICATE NUMBER: 1805446326 REVISION NUMRFR-
<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 />AOOLSUSR
<br />JNM
<br />wyo
<br />POLICYNUMBER
<br />POLICY EFF
<br />MM/DD/YYYY
<br />POLICY EXP
<br />MWDD
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE rx]
<br />Y
<br />Y
<br />6806H393952
<br />10/1/2021
<br />10/1/2022
<br />EACH OCCURRENCE
<br />$1,000,000
<br />PREMISES ES RENTED
<br />PREMIS Ea occurrence
<br />$1,000,000
<br />X
<br />MED EXP (Any one person)
<br />$10.000
<br />Contractual Liab
<br />Included
<br />PERSONAL S ADV INJURY
<br />$1,000,000
<br />AGGREGATE LIMIT APPLI ES PER:
<br />POLICY PRLOC
<br />GENERALAGGREGATE
<br />$2,000,000
<br />GEN'L
<br />PRODUCTS - COMP/OP AGO
<br />$2,000,000
<br />$
<br />OTHER:
<br />C
<br />AUTOMOBILE
<br />LIABILITY
<br />Y
<br />Y
<br />BA28471737
<br />10/1/2021
<br />10/1/2022
<br />COMBINED SINGLE LIMIT
<br />Fa .cadent
<br />$1,000,000
<br />X
<br />BODILY INJURY (Per person)
<br />$
<br />ANY AUTO
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />( BODILY INJURY Peracatlent )
<br />$
<br />X
<br />HIRED X NON -OWNED
<br />AIUTOS ONLY AUTOS ONLY
<br />PROPER I y UkMAGE
<br />Per accident
<br />$
<br />A
<br />X
<br />UMBRELLA LIAR
<br />X
<br />OCCUR
<br />Y
<br />Y
<br />CUP6C746237
<br />10/1/2021
<br />10/1/2022
<br />EACH OCCURRENCE
<br />$1,000,000
<br />AGGREGATE
<br />$1.000,000
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />DED I X I RETENTION$
<br />$
<br />A
<br />WORKERS COMPENSATION
<br />ANDEMPLOYERS-LIABILITY YIN
<br />Y
<br />UB7S159323
<br />10/1/2021
<br />10/1/2022
<br />X TPER
<br />STATUTE ERµ
<br />E.L. EACH ACCIDENT
<br />$1,000,000
<br />ANYPROPRIETOR/PARTNER/EXECUTIVE
<br />OFFICERIMEMBER EXCLUDED?
<br />N/A
<br />E.L. DISEASE -EA EMPLOYEE
<br />$1,000,000
<br />(Mandatory in NH)
<br />If yes, describe under
<br />E.L. DISEASE -POLICY LIMIT
<br />$1.000,000
<br />DESCRIPTION OF OPERATIONS be.
<br />B
<br />Professional Liability
<br />105677979
<br />9/9/2021
<br />9/9/2a22
<br />Per Claim
<br />$2,000,000
<br />Annual Aggregate
<br />$2,000,000
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, maybe atlachad If more space is required)
<br />Umbrella policy is follow -form to its underlying Policies: General Liability/Auto Liability/Employers Liability.
<br />RE: RFP #20-040, On -Call AS for City's Public Works Agency —
<br />the City of Santa Ana, its officers, employees, agents, volunteers and representatives are named as an additional insured as respects general 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). CANCELLATION/CHANGE: 30 day notice will be sent to the certificate holder.
<br />nolaer
<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 />City of Santa Ana, Risk Mgmnt Div.
<br />20 Civic Center Plaza, 4th Floor
<br />Santa Ana CA 92702
<br />U 1VI S-2U15 AGUKD Ct
<br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
<br />Risk Mmegeend Di ;
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