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Last modified
10/9/2024 4:10:53 PM
Creation date
11/16/2023 8:57:05 AM
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Contracts
Company Name
PSOMAS
Contract #
A-2020-241-34-02
Agency
Planning & Building
Council Approval Date
12/1/2020
Insurance Exp Date
4/1/2025
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ACCOR " CERTIFICATE OF LIABILITY INSURANCE <br />DATE (MM/DD/YYYY) <br />9/28/2024 <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 />AssuredPartners Design Professionals Insurance Services, LLC <br />3697 Mt. Diablo Blvd Suite 230 <br />Lafayette CA 94549 <br />CONTACT <br />NAME: Lisa Shimizu-Fookes <br />PHONE FAX <br />A/C No EXt : 714-427-3482 A/C, No): <br />ADDRESS: CertsDesignPro@AssuredPartners.com <br />INSURER(S) AFFORDING COVERAGE <br />NAIC # <br />INSURERA: XL Specialty Insurance Co. <br />37885 <br />License#: 6003745 <br />INSURED PSOMASO-01 <br />PSOMAS <br />INSURER B <br />865 S. Figueroa Street, Suite 3200 <br />INSURERC: <br />INSURER D : <br />Los Angeles CA 90017 <br />INSURER E : <br />INSURER F : <br />COVERAGES CERTIFICATE NUMBER: 1586487023 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 />TYPE OF INSURANCE <br />ADDL <br />I <br />SUBR <br />POLICY NUMBER <br />POLICY EFF <br />MM/DD/YYYY <br />POLICY EXP <br />MM/DDIYYYY <br />LIMITS <br />COMMERCIAL GENERAL LIABILITY <br />EACH OCCURRENCE <br />$ <br />CLAIMS -MADE OCCUR <br />DAMAGE TO RENTED <br />PREMISES Ea occurrence <br />$ <br />MED EXP (Any one person) <br />$ <br />PERSONAL & ADV INJURY <br />$ <br />GEN'L <br />AGGREGATE LIMIT APPLIES PER: <br />GENERAL AGGREGATE <br />$ <br />POLICY ❑ PRO JECT ❑ LOC <br />PRODUCTS - COMP/OP AGG <br />$ <br />$ <br />OTHER: <br />AUTOMOBILE LIABILITY <br />COMBINED SINGLE LIMIT <br />Ea accident <br />$ <br />BODILY INJURY (Per person) <br />$ <br />ANY AUTO <br />OWNED SCHEDULED <br />AUTOS ONLY AUTOS <br />BODILY INJURY (Per accident) <br />$ <br />PROPERTY DAMAGE <br />Per accident <br />$ <br />HIRED NON -OWNED <br />AUTOS ONLY AUTOS ONLY <br />UMBRELLALIAB <br />OCCUR <br />EACH OCCURRENCE <br />$ <br />AGGREGATE <br />$ <br />EXCESS LIAB <br />CLAIMS -MADE <br />DED RETENTION $ <br />$ <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY YIN <br />PER OTH- <br />STATUTE ER <br />ANYPROPRIETOR/PARTNER/EXECUTIVE <br />E.L. EACH ACCIDENT <br />$ <br />OFFICER/MEMBER EXCLUDED? ❑ <br />NIA <br />E.L. DISEASE- EA EMPLOYEE <br />$ <br />(Mandatory in NH) <br />If yes, describe under <br />DESCRIPTION OF OPERATIONS below <br />E.L. DISEASE - POLICY LIMIT <br />$ <br />A <br />Professional Liab & Poll. Liab <br />Y <br />DPR5033899 <br />10/15/2024 <br />10/15/2025 <br />Per Claim <br />$2,000,000 <br />Claims -Made Form <br />Aggregate Limit <br />$2,000,000 <br />Retro Date: 10/15/1947 <br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) <br />Additional Insured Status is not available on Professional Liability Policy. <br />3SAN050200 - Santa Ana Environmental and Planning Services, Santa Ana, CA. <br />Insurance coverage includes waiver of subrogation per the attached endorsement. <br />30 Dav Notice of Cancellation <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF. NOTICE WILL RE DELIVERED IN <br />ACCORDANCE WITH THE POLICY PRC <br />City of Santa Ana RiakMuwgernentDhb1crn <br />20 Civic Center Plaza xr REVIEWED & APPROVED BY: <br />Santa Ana CA 92701 AUTHORIZED REPRESENTATIVE r <br />-- Risk Management Specialist <br />© 1988-2015 ACORD <br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD <br />
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