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F ' Johnson -Frank & Associates, Inc. <br />WOn -Call Construction Surveying Services RFP No. 19-090 <br />Santa Ana Public Works Agency <br />At---- n` CERTIFICATE OF LIABILITY INSURANCE DATE,Y 111nnOOrfY <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, certaln 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 Insurance Services <br />CONTIOA Betty Tran <br />NAME Betty <br />130 Vantis. Suite 250 <br />A1i50 Viejo, CA 92fi5fi <br />PHONE FAx <br />J wa _ 1 949-297.5962 lA c Nil 94&297-5980, - <br />ADDRESS: betty tran@ioausa.cOm <br />INSURERISIAFFOROING COVEPAGE NAILS <br />WWW.*OUSa.ODm CALIoerwODE67768 <br />INaURERA: RLIinsurance Company 13056 <br />tNSUI= <br />Johnson -Frank & Associates, Inc. <br />IN SURER B : <br />5150 E- Hunter Avenue <br />INeuReRe: <br />Anaheim CA 92807 <br />INauReRD: <br />INBYRERE: <br />INSURER F: <br />Cr1VFRAGFS CFRTIFICATF NI1AII1 • AA9 RnR Rp"ffle W NIIYRFR- <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 />INaR LTR TYPE OF INSURANCE <br />POLICY NUMBER B POLICY Eli <br />P Y EIIP IJIMTe <br />A J COMMERCIAL GENERAL LIAMUTY <br />+/ PSB0001301 12012018 12/112019 EACHOCCURRENCE $1000000 <br />CI AIMS NtAOr J OCCUR <br />Scheduled Al Endt DAMAGE TO RENTED <br />n.raiwaJ $1,000,000 <br />✓ PrimMonCon <br />_ <br />MPPB MFV LXF'IAAy One MWIi $10000 <br />Processsionalional 2 Services <br />J Wvr of Subr <br />performed by the Insured PERSONAL a ADV INJURY 31 000 000 <br />GEN'L AGGREGATE LIMIT APPLIE5 PER <br />are Excluded GENERAL AGGREGATE_ 32.000,000 <br />POI ICY J jF o- J l nC <br />PROOUCTS - CnMPIOP ADG 32.000 ODO <br />01HER <br />3 <br />A AUTOMOBLELLAUMM <br />✓ PSA0001078 12)112018 1211/2019 ,EaaGC]ant+ 31.000000 <br />✓ ANYAUTO <br />Designated Insured Endl 1II Y INJAY;P. P�I S <br />OVALD SCHEDULED <br />#CA20481011 PdmlNonCon <br />e0O1LY EI.rt1RY LPN /Ct1011q 3 <br />_ AUTUS ONLY J AUTOS <br />HIRED NONO NED <br />and Blkt Wvr of Subr PROPERTY DAMAGE e <br />J AUTOS ONLY J AUTOS ONLY <br />included on pg 2 of Form ,Per —0"a <br />PrimMonCon Mr of Subir <br />#PPA3000313 3 <br />A UMBRELLAlLA33 / OCCUR <br />PSE0001230 12dIM18 12/1/2019 EACNOCCURRENCE $4.000000 <br />V EXCESS LIAR CLAIMS -MADE <br />Excludes Professional AGGREGATE s4 000 OW <br />LiabiltyTIONS i <br />DES RETEN <br />$ <br />A WORKERS COMPENSATION <br />✓ PSWDOC2298 12+112018 12/112019 J FIER STATUTE ERA I <br />ANO EMPLOYERS' UABILRY YIN <br />Waiver of Subrogation - ' <br />AtrrPRCGRiLtCrIFANINEWE%ECUnVE <br />OFF ICEWN EMBER ENCL UCED'/ <br />EL EACH ACCIDENT 31.000ODO <br />Nr• Endt#WG0403060484 - <br />1MandateryinNN) <br />E-L.DISEASE, EA EMPLOYEE S1,000.OD0 <br />I �ress dt•s:�I u k <br />DLSCRIPTION OF OPERATIONS Eei Y <br />E L DISEASE -POLICY LIMIT T 1.000 000 <br />A Professional Liability <br />RDP00344A8 12+112018 112l1,2019 $2,000.00D Each Claim <br />Claims -Made <br />S2.000.000 Aggregate <br />DESCRIPTION Of OPERATIONS I LOCATIONS 1 VEHICLES (ACORD 101. Additional Remarks Schedule, may Ee nteched It more space Is reuuired) <br />Certificate Holder is an Additional Insured with respect to General Liability (GL) and Automobile Liability but only when required by written contract <br />with the Insured prior to an occurrence as per Endorsements noted above. GL includes Separation of Insureds and Contractual Liability per limitations <br />in the BusinessOMmers' Coverage form. A Workers Compensation Waiver of Subrogation as noted above is included for the person or organization named <br />in the Schedule that are parties ID a contract requii this Endorsement, provided that contract is executed before the loss Coverage subject to all <br />policy terms conditions, limitations and exclusions 30 Day Notice of Cancelel0 Days for Non -Payment in accordance with policy provisions <br />r:FRTIFM'ATF 111n1 nii r-ARIr:FI I ATM1M <br />REP 17-009 and Agreement AA-2011-0984A-2017-159 <br />CITY of Santa Ana, its officers and employees <br />Y <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOT10E WILL BE DELIVERED IN <br />PO Box 1988 M-36 <br />Santa Ana CA 92702 <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />AUTHORIZED REPRESENTATIVE <br />.tr�!lyrJ r� <br />iAVCV AIIc+a K 1 ram <br />tE1988-ZU75 AGVRU GV RPVRA fION. All rights reserved. <br />ACORD 25 (201W03) The ACORD name and logo are registerad marks of ACORD <br />45:.a.I I- I _ ; I Ii .: T, t.; .FRr —.-yr•PLI -r...-, r.r, 1 1,;4 ;:.lid 1 _ I L I <br />5150 E. Hunter Ave. 35 Anaheim, CA 92807 <br />(714) 777-8877 alanfrank@johnson-frank.com FAX: (714) 777-1641 <br />