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Last modified
8/24/2022 1:31:02 PM
Creation date
8/16/2022 8:33:39 AM
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Contracts
Company Name
KTUA
Contract #
A-2022-151
Agency
Public Works
Council Approval Date
8/2/2022
Expiration Date
8/1/2025
Insurance Exp Date
9/1/2022
Destruction Year
2030
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A Diaitally signed <br />A� o® CERTIFICATE OF LIABILI�Y11�I WME by Angier 2d <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CCCCWFERS NO RIGHTS UP ' HE CA7 Cj�1� Yj1C� <br />CERTIFICATE DOES NOT AFFIRMATIVELY NEGATIVELY AMEND, EXTEN �JC+ G 1S •I•bL �ES <br />J. 6A_ <br />E <br />BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A C CT El J R7{1QJ{ ED <br />� <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 />CONTACT <br />NAME: Certificate Department <br />Cavignac <br />451 A Street, Suite 1800 <br />PHONE FAX <br />619-744-0574 rJC No :619-234-8601 <br />ADDRESS, certificates cavi nac.com <br />San Diego CA 92101 <br />INSURERS AFFORDING COVERAGE <br />NAICIt <br />INSURER A: Travelers Property Casualty Company of America <br />25674 <br />INSURED KTu&APL-0t <br />INSURER : Berkley Insurance Company <br />32603 <br />ICTU+A Planning & Landscape Architecture <br />3916 Normal Street <br />INSURER C : Travelers Indemnity Co of Conn <br />25682 <br />INSURER D : Property & Casualty Ins. Co. of Hartford <br />34690 <br />San Diego CA 92103 <br />INSURERE: <br />INSURER F : <br />COVERAGES CERTIFICATE NUMBER: 1184656208 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 />OF INSURANCE <br />ADDLTYPE <br />JUM <br />SUER <br />POLICYNUMBER <br />MMIDDPOLICYEFF <br />MMIUD/YPOLICY �ritP <br />Y <br />LIMITS <br />A <br />X <br />COMMERCIALGENERAL LU\BIUTY <br />Y <br />Y <br />68011-1979452 <br />9/1/2021 <br />9/1/2022 <br />EACH OCCURRENCE <br />$1,000,000 <br />CLAIMS -MADE OCCUR <br />DAMAGES RENTED <br />PREMISES Es ocwrrence <br />$1,000,000 <br />X <br />MED EXP (Any one person) <br />$10,000 <br />Cross Lieu <br />X <br />I Contractual Lieu <br />PERSONAL &ADV INJURY <br />$1,000,000 <br />GENT AGGREGATE LIMIT APPLIES PER: <br />GENERALAGGREGATE <br />$2.000,000 <br />X POLICY JEo I LOC <br />PRODUCTS - COMP/OP AGO <br />$2,000,000 <br />$ <br />OTHER: <br />C <br />Y <br />Y <br />BA2S035976 <br />9/1/2021 <br />9/1/2022 <br />COMBINED SINGLE LIMITEaaccident <br />$1,000,000 <br />BODILY I NJURY(Per person)$ <br />ANY AUTO <br />OWNED SCHEDULED <br />AUTOS ONLY AUTOS <br />PUTOMOBILELIABILITY <br />BODILY INJURY (Per accident) <br />$HIRED <br />X NON -OWNED <br />AUTOS ONLY AUTOS ONLY <br />PROPERTY DAMAGE <br />Per accentNoOwnedAutos <br />$ <br />$ <br />UMBRELLALIAB <br />OCCU <br />EACH OCCURRENCE <br />$ <br />AGGREGATE <br />$ <br />EXCESS LMB <br />CLAIMSR -MADE <br />DED RETENTION$ <br />$ <br />D <br />WORKERS COMPENSATION <br />ANDEMPLOYERS'LIABILITY YIN <br />Y <br />72WE0006436 <br />9/1/2021 <br />9/1/2022 <br />X PER OTH- <br />STATUTE ER <br />E.L. EACH ACCIDENT <br />$1,000,000 <br />ANYPROPRIETOR/PARTNEWEXECUTIVE <br />OFFICERIMEMBEREXCLUDED? <br />NIA <br />E.L. DISEASE - EA EMPLOYEE <br />$1,000,000 <br />(Mandatory in NH) <br />If yes, describe under <br />DESCRIPTION OF OPERATIONS be. <br />F.L. DISEASE -POLICY LIMIT <br />$1,000,000 <br />B <br />Professional Liability <br />AEC904730306 <br />9/1/2021 <br />9/1/2022 <br />Each Claim <br />$5,000,000 <br />1 ITI <br />Aggregate <br />$5,000,000 <br />DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be anached if more space is required) <br />Re: Safe Mobility Santa Ana Update Project LRSPL-5063(205) Agreement. <br />Additional Insured coverage applies to General Liability and Automobile Liability for the City of Santa Ana per policy form. Primary coverage applies to General <br />Liability and Automobile Liability per policy form. Waiver of subrogation applies to General Liability, Automobile Liability, and Workers Compensation per policy <br />form. Professional Liability - Claims made form, defense costs included within limit. <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 <br />20 Civic Center Plaza, M43 <br />Santa Ana, CA 92701 <br />©1988-2015 ACORD <br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD <br />THIS CERTIFICATE SUPERSEDES PREVIOUSLY ISSUED CERTIFICATE <br />Rink MrDMgemmLDivirfpn <br />REVIEWED&APPROVED BY: <br />Aar Ac&v,44 <br />rrv,%Twlmt <br />® <br />R hk Management Sped hlut <br />
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