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'. Dlglially signed bylrl Ple,sen
<br />TOrI Pierson Date: 21121.12.2210a2:56
<br />as,00.
<br />YtcHR&PE-U1
<br />MICHAELA
<br />DA11124/2021D0/1/24
<br />1
<br />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 poltcy(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 endorsements .
<br />PRODUCER License # DE67768
<br />CONEACT Gigl Yuen
<br />IDA Insurance Services
<br />3875 Hoppyard Road
<br />Suite 200
<br />PHONE
<br />(A/C, No, Ezt): (925) 660.3514 50008 (0AIc, No):(925) 416.7869
<br />e-MAIEBS: Gigi.Yuen@ioausa.com
<br />Pleasanton, GA 94588
<br />INSURER B AFFORDING COVERAGE
<br />NAIC N
<br />INSURER A:RLIInsurance Company
<br />13056
<br />INSURED
<br />INSURER a: Hartford Casualty Insurance Company
<br />29424
<br />INSURER C: 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: RFVISION 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 />INSR
<br />TYPE OF INSURANCE
<br />ADDL
<br />INSI)
<br />SUBR
<br />MD
<br />POLICY NUMBER
<br />POLICY EFF
<br />POLICY EXPLTR OnIn
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE ❑X OCCUR
<br />PS60006683
<br />121612021
<br />1216/2022
<br />EACH OCCURRENCE
<br />2,000,000
<br />pAE AG ET RENTED
<br />nce
<br />1,000,000
<br />MED EXP (Anyone arson
<br />10,000
<br />PERSONAL&ADV INJURY62,000,000
<br />LIMIT APPLIES PER:
<br />P {)T LOG
<br />GENERAL AGGREGATEPOLICY
<br />GEN'LAGGREGATE
<br />PRODUCTS-COMP/OP AGGOTHER:APOMOBILIE
<br />LIABILITY
<br />COMBINEDSINGLE LIMITEea ,denANY
<br />BODILY INJURY Per arsonOWNED
<br />AUTO
<br />SCHEDULED
<br />AUpTOS ONLY AUTOS
<br />PSA0002276
<br />1216/2021
<br />1216/2022
<br />BOOpDILY Per accident
<br />INJURY
<br />0P.Ec Rdan AMACE
<br />$
<br />AUTOS ONLY X AUTOSONLV
<br />A
<br />UMBRELLA LIAR
<br />X
<br />OCCUR
<br />EACH OCCURRENCE
<br />$ 5,000,000
<br />X
<br />A
<br />AGGREGATE
<br />$ 5,000,000
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />PSE0002889
<br />121612021
<br />121612022
<br />DED RETENTION$
<br />B
<br />ANO EMPLOYERS' COMPENSATION
<br />YIN
<br />ANY PROPRIETORIPARTNERIEXECUTIVE
<br />(W�pFILE=��MEMBW EXCLUDED?
<br />(Mandb my9ib NH)
<br />Matt]... describe untler
<br />DESCRIPTION OF OPERATIONS below
<br />NIA
<br />57WEGZJ1989
<br />5/1/2021
<br />51112022
<br />X STATUTE OTH-
<br />E.L. EACH ACCIDENT
<br />1,000,000
<br />$
<br />E.L. DISEASE EA EMPLOYE
<br />$ 1,000,000
<br />E.L. DISEASE POLICY LIMIT
<br />�75,000,000
<br />$ 1,000,000
<br />C
<br />Professional Liab,
<br />AEXNYABEFJ2006
<br />12/6/2021
<br />121612022
<br />Per Claim
<br />5,000,000
<br />C
<br />Professional Liab.
<br />AEXNYABEFJ201
<br />1216/2021
<br />1216/2022
<br />Aggregate
<br />DESCRIPTION OF OPERATIONS / LOCATIONS /VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached If more space Is required)
<br />P19.1593 Santa Ana On -Call VMT - OC20-0710.00, OC20.0710.01 & OC19-STAN.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(S): 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 />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
<br />City of Santa Ana AUTHORIZED REPRESENTATIVE AFraoaeD8r. `' r RHkMwu&nMmtTNdsLm
<br />Risk Management Division p REvHEo&
<br />20 Civic Center Plaza t)rr idrGtcraarc
<br />ISanta Ana- CA 92702 Rick14megenormCm'mlAide
<br />ACORD 25 (2016/03) ©1988.2015 ACORD C(
<br />The ACORD name and logo are registered marks of ACORD
<br />
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