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Francine K. Villareal vua,esl
<br />Dace:2021ns.2008:03:5 -07W
<br />A� �® CERTIFICATE OF LIABILITY INSURANCE
<br />DAM(MMI02
<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 endorsements).
<br />PRODUCER
<br />AssuredPartners of Washington, LLC
<br />A/E Insurance Services
<br />CONTACT
<br />Allison Bar a CA Lic # OK93926
<br />PNAME
<br />HONE Fax
<br />a Ert, 360-626-2007 aC No:360-598-3703
<br />No.
<br />19660 10th Ave NE
<br />ADDRESS: allison.barga@assuredpartners.com
<br />Poulsbo WA 98370
<br />INSURER(S) AFFORDING COVERAGE
<br />NAIC9
<br />INSURERA: Underwriters at Lloyd's, London/AEGIS
<br />INSURED 26221
<br />John Robinson Consulting Inc
<br />1055 East Colorado Blvd Suite 500
<br />INSURER B: RLI INSURANCE COMPANY
<br />13056
<br />INSURERC:
<br />INSURER D:
<br />Pasadena CA 91106
<br />INSURER E :
<br />_
<br />INSURER F :
<br />COVERAGES CERTIFICATE NUMBER: 1340530486 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 />ADDLSUBR
<br />POLICY NUMBER
<br />POLICY EFF
<br />MM/DD
<br />POLICY EXP
<br />MM/DD
<br />LIMITS
<br />B
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE I OCCUR
<br />PSB0009419
<br />5/9/2021
<br />5/9/2022
<br />EACH OCCURRENCE
<br />$1,000,000
<br />DAMAGERENTED
<br />Ea PREMISESS occurrence
<br />$1,000,000
<br />MED EXP (Any one person)
<br />$10,000
<br />PERSONAL S ADV INJURY
<br />$1,000,000
<br />GEN'L
<br />AGGREGATE LIMIT APPLIES PER:
<br />� JECOT1:1 LOG
<br />GENERAL AGGREGATE
<br />PRODUCTS-COMP/OP AGOOTHER:
<br />B
<br />AUTOMOSILELIABILITY
<br />PSBOOD9419
<br />5/9/2021
<br />5/9/2022
<br />COMBINED SINGLE LIMIT Ea accidentANY
<br />BODILY INJURY(Per parson)
<br />rs2,000,000POLICY
<br />AUTO
<br />OWNED SCHEDULED
<br />ONLY AUTOS
<br />BODILY INJURY Per accidentAUTOS
<br />( 1X
<br />HIRED X NON -OWNED
<br />ONLY AUTOS ONLY
<br />PROPERTY DAMAGEAUTOS
<br />Per accident
<br />B1-1
<br />UMBRELLA LIAR
<br />X
<br />OCCUR
<br />PSE0004657
<br />5/9/2021
<br />5/9/2022
<br />EACH OCCURRENCE
<br />$3,000,000
<br />X
<br />AGGREGATE
<br />$3,000,000
<br />EXCESS WAB
<br />CLAIMS -MADE
<br />IED I RETENTION$
<br />$
<br />B
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY YIN
<br />ANYPROPRIETORIPARTNER/EXECUTIVE
<br />OFFICER/MEMBEREXCLUDED'!
<br />NIA
<br />PSW0005179
<br />5/9/2021
<br />5/9/2022
<br />X SEATUTE EORH
<br />E.L. EACH ACCIDENT
<br />$1,000,000
<br />E.L. DISEASE -EA EMPLOYEE
<br />$1,000,000
<br />(Mandatary in NH)
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE -POLICY LIMIT
<br />$1,000,000
<br />A
<br />Professional Lam: Claims Made
<br />1525/20U10119/109
<br />5/9/2021
<br />5/9/2022
<br />$2,000,000 Per Claim
<br />$2,000,000 Aggregate
<br />DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required)
<br />Re: Revision to the City's Recycled Water Master Plan
<br />Agreement #N-2021-019
<br />the City, its officers, employees, agents, volunteers and representatives are an additional insured per the attached. 30 day notice of cancellation applies per the
<br />attached.
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />City of Santa Ana ACCORDANCE WITH THE POLICY PROVISIONS.
<br />Risk Management Division
<br />20 Civic Center Plaza, 4th Floor AUTHORIZED REPRESENTATME
<br />Santa Ana CA 92701 / Z 7_ 4 j% gs xWrMe,.ganaduMerwt
<br />(� Y"'^ F REVIEWED & APPROVED Br.
<br />©1988-2015 ACORD Ci F4+� P, vt[uwl
<br />ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD ®'
<br />Risk Management Analyst
<br />
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