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ENGINEERING SOLUTIONS SERVICES
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Last modified
5/2/2022 8:29:44 AM
Creation date
4/14/2022 2:28:01 PM
Metadata
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Template:
Contracts
Company Name
ENGINEERING SOLUTIONS SERVICES
Contract #
A-2022-041
Agency
Public Works
Council Approval Date
4/5/2022
Expiration Date
8/15/2022
Insurance Exp Date
8/19/2022
Destruction Year
2027
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FrancineR. <br />VIIIdledI <br />a CERTIFICATE OF LIABILITY INSURANCE <br />DATE(MM/DONYYY) <br />08/2s/21 <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 />PRIME INSURANCE SERVICES, INC. <br />9891 IRVINE CENTER DRIVE #160 <br />IRVINE, CA 92618-4319 <br />License#:OD48024 <br />CONTAGTElhe <br />PHONE 949 450-2310 FAx No,(949)450-2311 <br />E-MAL .e ie prmmepo icy.com <br />INSURERS AFFORDING COVERAGE <br />NAIL# <br />IMSURFRA.SENTINEL INSURANCE COMPANY <br />11000 <br />INSURED ENGINEERING SOLUTIONS SERVICES INC. <br />SUDABEH SHOJA <br />23232 PERALTA DR., SUITE 112 <br />LAGUNA HILLS, CA 92653 <br />949 637-1405 <br />INSURERS: KINSALE INSURANCE CO. <br />38920 <br />INSURER,HARTFORD ACCIDENT S INDEMNITY <br />22357 <br />INSURER,, CFC Underwriting -Lloyds of London <br />INSURERF <br />rMIPPAOCe rFGTIFIrATF rill InnGFa• OEseQ111KI a„hJpPEF3 <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 />Lm <br />tFF <br />TYPE OF INSURANCE <br />D <br />POLICYINS <br />POLICY EXP <br />LIMITS <br />X <br />COMMERCIAL GENERAL LIABILITY <br />EACH OCCURRENCE <br />$ 2,000,000 <br />CLAIMSWADE ElOCCUR1,000,000 <br />MEO EXP An one m.n <br />10.000 <br />PERSONAL$ ADV INJURY <br />2,000,000 <br />A <br />X <br />x <br />72SBAIT9447 <br />8/19/2021 <br />/19/2022 <br />GENT AGGREGATE LIMIT APPLIES PER-. <br />GENERAL AGGREGATE <br />$ 4,000,000 <br />X POLICY ❑PRO- OLOC <br />JECT <br />PRODUCTS - COMPIOP AGO <br />$ 4,000,000 <br />$ <br />OTHER <br />AUTOMOBILE LIABILITY <br />COMBINED SINGIT, LIMIT <br />$ <br />ANYAUTO <br />BODILY INJURY (Protons..) <br />$ <br />C <br />OWNED SCHEDULED <br />R AUTOS ONLY AUTOS <br />XXBODILY <br />72UECCD2464 <br />5/1/2D21 <br />/1/2D22 <br />INJURY (PrramitlenQ <br />$ <br />HIRED NON -OWNED <br />P <br />PROPERTY DAMAGE <br />AUTOS ONLY AUTOS ONLY <br />UMBRELLA LIAB <br />OCCUR <br />EACH OCCURRENCE <br />AGGREGATE <br />P <br />EXCESS LIAB <br />CLAIMS -MADE <br />WORKERS COMPENSATION <br />T - <br />X PERTUT <br />AND EMPLOYERS'LIABILITYANY PROPRIETORIPARTNERIEXECUTIVE <br />ELEACH ACCIDENT <br />00 <br />C <br />OFFICERIMEMBER P.CWDED9 Y <br />N/A <br />][ <br />E.L. DISEASE - EA EMPLOYEE <br />r <br />tMandatory in NH) <br />72WECGG6984 <br />8/20/2021 <br />/20/2022 <br />Oyes, describe under <br />DESCRIPTION OF OPERATIONS belm <br />E L DISEASE - POLICY LIMIT <br />5 1 ,000,000 <br />A <br />BUSINESS PERSONAL PROPERTY <br />72SBAIT9447 <br />8/19/2021 <br />/19/2022 <br />B. P.P <br />$14,300 <br />x <br />D. <br />PROFESSIONAL LIABILITY <br />PSK0132755912 <br />8/29/2021 <br />/29/2022 <br />PLIABILITY <br />$5M/$5M <br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Addi anal Remarks Schedule, may be atlachedrf more space is required) <br />City of Santa Ana, its officers, employees, agents and representatives are Additional Insureds <br />with respect to General and auto Liability per attached Endorsements as required by written <br />contract. Insurance is Primary and Non -Contributory. Waiver of Subrogation applies to Worker's <br />Compensation. 30 day notice of Cancellation with 10 day notice for non-payment of premium in <br />accordance with the policy provisions. <br />ESS's amended agreement number: 2017-224-01. <br />City of Santa Ana <br />Risk Management Division <br />20 Civic Center Plaza, 4th Floor <br />Santa Ana, CA 92702 <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 />AUTHORIZED REPRESENTATIVE <br />©1988-2015 ACORD CC <br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD <br />�y-1 ^a Ride MawgemmEDivelon <br />a+/ :_q`,,_ REVIEWED6(AIPrROV9]8Y. <br />.I , f AOvh(NMv R. V� <br />Rok Management Analyst <br />
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