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Tori Pierson o:9 RPo 11.121 && 6eoa.na ACORO� CERTIFICATE OF LIABILITY INSURANCE DATE (MM'12021 Y 12121 2021 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER AssuredPartners Design Professionals Insurance Services, LLC 3697 Mt. Diablo Blvd Suite 230 Lafayette CA 94549 CONTACT NAME: Marie Swaney PHONE FAX ac Net noo IEss: Desi nProCerts AssuredPartnem.com INSURER(S) AFFORDING COVERAGE NAIC# INSURER A: XLSpecialty Insurance Company 37885 License#: 6003745 INSURED JOHNKAL-01 John Kaliski Architects dba John Kaliski Arch. INSURER B: Travelers Property Casualty Company of America 25674 213 383-7980 INSURER C INSURER D : 3780 VV Ishire Blvd., Suite 300 Los Angeles, CA 90010 INSURERE: INSURER F : COVERAGES CERTIFICATE NUMBER-767782830 RFVISIOM NIIMRFR- THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDLSUBR INSD WM POLICY NUMBER POLICYEFF IMMIDOMWI POLICY EXP IMMIDD/YYYY1LIMITS B X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE M OCCUR Y Y 68051-1299911 12/13/2021 12/13/2022 EACH OCCURRENCE $2,000.000 PREMISES Ea bex ED PREMISES Ea occurrence $1,000,000 X MED EXP (Any one person) $ 10,000 Contractual Liab Included PERSONAL &ADV INJURY $2,000,000 AXCU GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO- JECT LOC GENERALAGGREGATE $4,000,000 PRODUCTS - COMP/OP AGO $4,000,000 $ OTHER: B AUTOMOBILE LIABILITY Y Y BA2R339045 12/13/2021 12/13/2022 COMBINED SINGLE LIMIT $1,000,000 X BODILY INJURY (Par person) $ ANY AUTO OWNED SCHEDULED AUTOS ONLY AUNON-OWNEDauitlent IAUTOS BODILY INJURY (Per ) $ X HIRED X NON -OWNED ONLY AUTOS ONLY PROPERTY DAMAGE Per accident $ UMBRELLALIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED I RETENTION$ $ B WORKERS COMPENSATION AND EMPLOYERS'LIABILITY YIN Y UB8M739089 12/13/2021 12/13/2022 X STATUTE OEftH E.L. EACH ACCIDENT $1.000.000 ANYPROPRIETOWPARTNEWEXECU-IVE OFFICER/MEMBEREXCLUDED? NIA E.L. DISEASE - EA EMPLOYEE 51, 000.000 (Mandatory in NH) If yes, describe under E.L. DISEASE -POLICY LIMIT 51, 000.000 DESCRIPTION OF OPERATIONS below A Professional Liability DPR9986965 12/13/2021 12/13/2022 Per Claim $1,000.000 Aggregate Limit $2,000.000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) Re: On -call services, 0210 141125 -- City of Santa Ana, its officers, employees, agents, volunteers and representatives are named as additional insured as respects general & auto liability as required per written contract or agreement. General Liability is Primary/Non-Contributory per policy form wording. Insurance coverage includes waiver of subrogation per the attached endorsement(s). City of Santa Ana Risk Management Division 20 Civic Center Plaza, 4th Floor Santa Ana CA 92702 FIVARka\•I\D14BIWAII I -PAIR au1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Rldt Maraganpd DMdna -dia li %du prcAtea IS)1oaR_2n1s Arnan rr 1 a:;u M.nage„e„r uR,r.'Ind� '.. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD K