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A� " CERTIFICATE OF LIABILITY INSURANCE
<br />DATE (MM/DD/YYYY)
<br />8/26/2024
<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 Profe ionals Insurance lervices, LLC
<br />3697 Mt. Diablo Blvd Suite 23
<br />Lafayette CA 94549
<br />AIN
<br />CONTACTNAME: Anni Owens
<br />P,aHic°NN Ext : 10-2
<br />2-
<br />•
<br />E-MAIL —
<br />ADDRESS: Ce F` Desl
<br />n
<br />sure
<br />ners.co
<br />RER(S) AFFORDING VERAGE
<br />NAIC #
<br />� I e
<br />INSURERA: BF n C
<br />32603
<br />License#: 6003745
<br />INSURED MIGINCO-01
<br />MIG, Inc.
<br />Moore lacofano Goltsman, IAceived
<br />INSURER B: T ayei rs Prope'Roy Casualty Company of America
<br />25674
<br />25682
<br />INsuRERc • i�he Tr v. }9ItteFlit a
<br />U `�- •
<br />C n is t
<br />•
<br />Hearst Ave
<br />URER r ;
<br />Berkeley CA 94710
<br />Berkeley
<br />u cE'.E, 1 �
<br />I'SU'.ER F :
<br />• •
<br />COVERAGES CERTIFICATE NUMBER: 1921223621 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 />ADDLSUBRTYPE
<br />INSD
<br />WVD
<br />POLICY NUMBER
<br />EFF
<br />MM/DDPOLICY/YYYY
<br />Y EXP
<br />MM DD/YYYY
<br />LIMITS
<br />C
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />Y
<br />Y
<br />6801H899998
<br />8/31/2024
<br />8/31/2025
<br />EACH OCCURRENCE
<br />$1,000,000
<br />FIV-1
<br />CLAIMS -MADE OCCUR
<br />DA AGE To RENTED
<br />'REM SES (E. occurrence)
<br />$ 1,000,000
<br />X
<br />MED EXP (Any one person)
<br />$ 10,000
<br />Contractual Liab
<br />Included
<br />PERSONAL & ADV INJURY
<br />$1,000,000
<br />GEN'LAGGREGATE
<br />LIMIT APPLIES PER:
<br />GENERAL AGGREGATE
<br />$2,000,000
<br />� PECOT- LOC
<br />PPOLICY
<br />PRODUCTS - COMP/OP AGG
<br />$ 2,000,000
<br />$
<br />OTHER:
<br />C
<br />AUTOMOBILE LIABILITY
<br />Y
<br />Y
<br />BADS579947
<br />8/31/2024
<br />8/31/2025
<br />COMBINED SINGLE LIMIT
<br />Ea accident
<br />$1,000,000
<br />BODILY INJURY (Per person)
<br />$
<br />X ANY AUTO
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />BODILY INJURY (Per accident)
<br />$
<br />PROPERTY DAMAGE
<br />Per accident
<br />$
<br />X HIRED X NON -OWNED
<br />AUTOS ONLY AUTOS ONLY
<br />B
<br />X
<br />UMBRELLA LIAB
<br />X
<br />OCCUR
<br />Y
<br />Y
<br />CUPOH758762
<br />8/31/2024
<br />8/31/2025
<br />EACH OCCURRENCE
<br />$10,000,000
<br />AGGREGATE
<br />$ 10,000,000
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />DED X RETENTION $ n
<br />$
<br />B
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY Y / N
<br />Y
<br />UB2L553909
<br />8/31/2024
<br />8/31/2025
<br />X PER OTH-
<br />STATUTE ER
<br />ANYPROPRIETOFUPARTNEFUEXECUTIVE
<br />E.L. EACH ACCIDENT
<br />$1,000,000
<br />OFFICEFUMEMBEREXCLUDED?
<br />N/A
<br />E.L. DISEASE - EA EMPLOYEE
<br />$ 1,000,000
<br />(Mandatory in NH)
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE - POLICY LIMIT
<br />$ 1,000,000
<br />A
<br />Professional Liability &
<br />AEC907002005
<br />8/31/2023
<br />10/31/2024
<br />Per Claim/5,000,000
<br />$5,000,000/Aggr
<br />Contr. Pollution Liab Included
<br />Included
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
<br />The Umbrella Policy is follow form to its underlying Policies: General Liability/Auto Liability/Employers Liability.
<br />RFP No. 23-010. Project: California Environmental Quality Act (CEQA).
<br />City of Santa Ana, its officers, officials, employees, and volunteers are named as an additional insured as respects general liability and auto liability as required
<br />per written contract. General Liability is Primary/Non-Contributory per policy form wording. Insurance coverage includes waiver of subrogation per the attached
<br />endorsement(s).
<br />CERTIFICATE HOLDER CANCELLATION 30 Day Notice of Cancellation
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF. NOTICE WILL BE DELIVERED IN
<br />City of Santa Ana ACCORDANCE WITH THE POLICY PRC
<br />20 Civic Center Plaza (M-30) Risk ManagemadDivision
<br />P.O. Box 1988 AUTHORIZED REPRESENTATIVE 3I,, 'zREmEWED & APPROVED BY.
<br />Santa Ana CA 92702-1988 `i,�;¢ f�cevedo
<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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