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Tori Pierson Dsto 2'021.115115:;e0•Qe•
<br />CSGCONS-01
<br />HILL
<br />,w�oRo CERTIFICATE OF LIABILITY INSURANCE
<br />DAT1171217120r(vrv)
<br />2021
<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 />Alliant Insurance Services, Inc.
<br />575 Market St Ste 3600
<br />San Francisco, CA 94105
<br />N eEACT Melissa Hill
<br />PHONE , EXQ: FAX
<br />No ):
<br />J-DOAa . Melissa.Hill@alliant.com
<br />INSLNER(SI AFFORDING COVERAGE
<br />NAIC R
<br />INSURER A:Travelers Property Casualty Company of America
<br />25674
<br />INSURED
<br />INSURER BArch Insurance Company
<br />11150
<br />INSURER C:
<br />CSG Consultants, Inc.
<br />INSURER O:
<br />550 Pilgrim Drive
<br />Foster City, CA 94404
<br />INSURER E
<br />INSURER F:
<br />COVERAGES CFRTIFICATF NIIMRFR• oomclnu NnrARco.
<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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
<br />CERTIFICATE MAYBE 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 />AODLSUBR
<br />POLICY NUMBER
<br />POLICY EFF
<br />POLICY EXPJJE.
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE [ X] OCCUR
<br />X
<br />P-660-5R143841-TIL-21
<br />121412021
<br />121412022
<br />EACH OCCURRENCE
<br />S 1,000,000
<br />PREMISES UEa DAMAGETORENTEonce
<br />$ 1,000,000
<br />$ 10,000
<br />MED UP (Any one redo
<br />PERSONAL a ADV INJURY
<br />$ 1,000,000
<br />AGGREGATE LI MIT APPLIES PER:
<br />POLICY [X]JECpT LOC
<br />GENERALAGGREGATE
<br />$ 2,000,000
<br />GEN'L
<br />-'
<br />PRODUCTS -COMPIOP AGG
<br />$ 2,000,000
<br />$
<br />OTHER:
<br />A
<br />AUTOMOBILE
<br />LIABILITY
<br />-
<br />EO acccidentSINGLE LIMIT
<br />$ 1,ggg ggg
<br />X
<br />ANY AUTO
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />X
<br />810.51R143576-21-43-G
<br />12/4/2021
<br />1214/2022
<br />BODILY INJURY Per rscm
<br />$
<br />BODILY INJURY Peracodenl
<br />$
<br />FOPERTY DAMAGE
<br />fgeracadent
<br />$
<br />X
<br />HIRED Na.N-,pWNED
<br />AUTOS ONLY AUTOS ONLY
<br />aDawned Amos
<br />Comp/Call Ded.
<br />2,000
<br />A
<br />X
<br />UMBRELLA LIAB
<br />EXCESS LIAB
<br />X
<br />OCCUR
<br />culMs-MADE.
<br />- _
<br />CUP-7S954134-21-NF:
<br />12/412021
<br />12J412022
<br />EACH OCCURRENCE
<br />$ 5,000,000
<br />AGGREGATE
<br />$ 5,000,000
<br />DED I X I RETENTION$ 10,000
<br />A
<br />WORKERAND S COMPENSATION
<br />YIN
<br />ANY PROPMETORIPARTNERJEXECUTIVE
<br />OFFICER/MEMBER EXCLUDED' ❑Y
<br />(MantlatdlY in NH)
<br />Dyes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />N/A
<br />UB-5R147157-21-43-G
<br />121412021
<br />1214/2022
<br />ORH
<br />X STATUTE
<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 />$ 1,000,000
<br />B
<br />Professional Liab. -
<br />PAAEP0008806 -
<br />121412021
<br />121412022
<br />Ded: $50,000; Agg:
<br />5,000,000
<br />DESCRIPTION OF OPERATIONS LOCATIONS I VEHICLES `ACORD 101. Additional Remarks Schedule, ma be attached if more space is required)
<br />Re: Consultant Agreement for Municipal Plan Check Services City of Santa Ana, officers, agents, employees, and volunteers are named as additionally
<br />insured on this policy pursuant to writtencontract, agreement, or memorandum of understanding. Such insurance as Is afforded by this policy shall be
<br />primary, and any insurance carried by City shall be excess and noncontributory per general liability and automobile liability per attached endorsements. 30
<br />Day Notice of Cancellation on Professional Liability per attached.
<br />City of Santa Ana
<br />Risk Management Division
<br />20 Civic Center Plaza, 4th Floor
<br />Santa Ana, CA 92701
<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 />onto.
<br />AU(�THORRED REPRESENTATIVE f�. REAE%En L ApgyW®r
<br />1,J ��
<br />yRnan>a,,.,ye,a„tacd(
<br />AGVHU ZO tZU101U3) ©1988-2015 ACORD CC it v
<br />The ACORD name and logo are registered marks of ACORD
<br />
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