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Digitally slynetl by Ted Plerson
<br />A-2018-015-02 Tori Plerson Date:Il43o3.3o15Ay23-o7aay
<br />WOOLINC-01 KSUTTON
<br />.4CORL7° CERTIFICATE OF LIABILITY INSURANCE
<br />�--�
<br />DATE(MM/DDIYYYV)
<br />2128/2022
<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 endorsement(s).
<br />PRODUCER
<br />C09JACT
<br />NA
<br />Ames & Gough
<br />8300 Greensboro Drive
<br />Suite 980
<br />a/c°, No, Ext 703 827-2277 FAX
<br />( 1: ( ) (A/C, No):(703) 827-2279
<br />%Nfiss; admin@amesgough.com
<br />McLean, VA 22102
<br />INSURERS AFFORDING COVERAGE
<br />NAIC #
<br />INSURERA: Travelers Inde nnitv Co. of America A++ XV
<br />25666
<br />INSURED
<br />INSURERS: Phoenix Insurance Company A++XV
<br />25623
<br />INSURER C: Travelers Property Casualty Company of America
<br />25674
<br />Woolpert Inc.
<br />INSURER D: National Union Fire Insurance Company
<br />19445
<br />4464 Idea Center Boulevard
<br />Dayton, OH46430-1600
<br />INSURER E : Continental CasualtyCompany CNA) A XV
<br />20443
<br />INSURER F:
<br />COVERAGES CERTIFICATE NUMBER: 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 CONTRACTOR 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 />LTHINSD
<br />TYPE OF INSURANCE
<br />ADDL
<br />SUBR
<br />D
<br />POLICY NUMBER
<br />POLICY EFF
<br />MWDD
<br />POLICY EXP
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE OCCUR
<br />LJ�jPREMISES
<br />P6309PS81661
<br />3/112022
<br />W112023
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />DAMAGE TO RENTED
<br />Ea occurrence
<br />$ 1,000,000
<br />MEO EXP An one erson
<br />$ 5,000
<br />PERSONAL B ADV INJURY
<br />$ 1,000,000
<br />AGGREGATE LIMIT APPLIES PER:
<br />POLICY � TEO1:1 LOC
<br />GENERAL AGGREGATE
<br />$ 2,000,000
<br />GEN'L
<br />PRODUCTS-COMP/OP AGG
<br />$ 2,000,000
<br />$
<br />OTHER:
<br />B
<br />AUTOMOBILE
<br />LIABILITY
<br />COMBINED SINGLE LIMIT
<br />Ee accident
<br />$ 1,000,000
<br />BODILY INJURY Per serson
<br />$
<br />X
<br />ANY AUTO
<br />8109P881648
<br />311/2022
<br />3/1/2023
<br />OWNED F SCHEDULED
<br />AU�gqT��O��S ONLY AUTTOSyyNEp
<br />BOODI LYRINJURY Per accident
<br />$
<br />AUTOS ONLY A�TO ONLY
<br />PPeOr ecAdenl AMAGE
<br />$
<br />C
<br />X
<br />UMBRELLA LIAB
<br />X
<br />OCCUR
<br />EACH OCCURRENCE
<br />$ 10,000,000
<br />AGGREGATE
<br />$ 10,000,000
<br />EXCESS LIAB
<br />CLAIMS MADE
<br />CUP-1T790932-22-NF
<br />311/2022
<br />3/112023
<br />DED X I RETENTION$ 10,000
<br />D
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS'LIABILITYy/N
<br />ANY pP�T'N'ETgO�R EXCLUDED' ECUTIVE
<br />(Mantlataryin BER EXCLUDED' N
<br />NHI
<br />It yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />NIA
<br />11326673
<br />31112022
<br />31112023
<br />X STATUTE ERH
<br />E.L. EACH ACCIDENT
<br />_
<br />$ 1,000,000
<br />E.L. DISEASE-EAEMPLOVE
<br />$ 1,000,QQQ
<br />E.L. DISEASE - POLICY LIMIT
<br />$ 1,000,000
<br />E
<br />Professional Liab.
<br />AEH288355072
<br />3/112022
<br />3/112023
<br />Per Claim/Aggregate
<br />2,000,000
<br />DESCRIPTION OF OPERATIONS / LOCATIONS! VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is mqulmna
<br />RE: PROJ #78392 — RFP #17-101
<br />The City of Santa Ana, its officers, employees, agents, volunteers and representatives are included as additional insured with respect to General Liability
<br />when required by mitten contract. General Liability includes Additional Insured coverage for On -Going & Completed Operations as required by written
<br />contract. General Liability is primary and non-contributory over any existing insurance and limited to liability arising out of the operations of the named
<br />insured and when required by written contract. 30-day Notice of Cancellation will be issued for the General Liability, Automobile Liability, Umbrella Liability,
<br />Workers Compensation and Professional Liability policies in accordance with policy terms and conditions.
<br />City of Santa Ana
<br />Risk Management Division, 4th Floor
<br />20 Civic Center Plaza
<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 PROVE""""
<br />RAMlavgadmreUtMafoa
<br />%UTHORIZED REPRESENTATIVE RwEluED&APParD ft
<br />61
<br />O' � -- r`7 MsaMana9c.,+�.aoAi�fwde
<br />ACORD 25(2016103) ©1988-2015 ACORD C(
<br />The ACORD name and logo are registered marks of ACORD
<br />
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