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GILL&PA•01 ROSEM
<br />41C�i2C3 CERTIFICATE OF LIABILITY INSURANCE
<br />OAT 613120A'YYY)
<br />5/3/2014
<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 BYTHEPOLICIES
<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 be endorsed. If SUBROGATION IS WAIVED, subject to
<br />the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the
<br />certificate holder In lieu of such endorsement(s).
<br />PRODUCER License # OES7768
<br />IDA Insurance Services -SD
<br />4350 La Jolla Village Drive, Suite 900
<br />San Diego, CA 92122A
<br />lison
<br />PHONeFA
<br />1� No S.0, (619) 574.5220 lac No): (?19) 574.6288__
<br />-MAI Erica,WilSon@ioausa.com
<br />INSURERIS) AFFORDING COVERAGE NAIC4
<br />INSURER A: RLI insurance Company 13056
<br />_
<br />INSURED
<br />Gillis & Panichapan Architects, IncorporatedINSURER
<br />2900 Bristol St. Suite G206
<br />Costa Mesa, CA 92825
<br />I•I
<br />INSURER e; Atlantic Specialty Insurance COmpan 27154
<br />C:
<br />INSURER 0:
<br />E:
<br />_INSURER
<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 SEEN REDUCED BY PAID CLAIMS.
<br />LTR
<br />TYPEOFINBURANOS
<br />A'DD
<br />He
<br />$RBRr^"'—BER
<br />POLICY NUM
<br />POLICY
<br />C YFFF
<br />P /00/Y P
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY LIABILITY
<br />EACH OCCURRENCE
<br />$ 1,000, mi
<br />CIAIMS-MADE X7 OCCUR
<br />X
<br />PSBO001119
<br />0712412013
<br />07124/2014
<br />pRU�M8E�9�acourrer¢a
<br />$ 1,000,00
<br />X
<br />MEO EXP (Any on person)
<br />'$ 10,00
<br />Contractual Llab.
<br />PERSONAL&ADV INJURY
<br />I$ 1.000,00
<br />GEN% AGGREGATE LIMITAPPLIES PER:
<br />GENERAL AGGREGATES_ 2,000,00
<br />E-1 PRO. (�
<br />POLICY C� JECT J LOC
<br />. _.�.�
<br />PRODUCTS-COMPIOP AGG $ 2,000,00
<br />$
<br />OTHER:
<br />I
<br />AUTOMOBILE LIAaILITY
<br />O BINEDISINGLE LIMIT $ 1,000,00
<br />f6aA
<br />BODILY INJURY(Perpanon) $
<br />X ANYAUTO
<br />PSAOGOI116
<br />06/0112014
<br />08101120151
<br />l ALLOWNEDOS . 80HEOULED
<br />AAU70S
<br />'—I NOT%OWNED
<br />�,.._ HIRED AUTOS ,AUTOS
<br />X Comp 57,000 X Coll $1,000
<br />BODILY INJURY (PoraccMonU $
<br />ROPER DAA $
<br />Per aeeldere
<br />$
<br />IX
<br />A
<br />UMBRELLA LIAR
<br />EXCESS LIAO
<br />X
<br />OCCUR
<br />CLAIMS•MAOE
<br />iPSE0001038
<br />07/2412013
<br />07124/2014
<br />EACH OCCURRENCE_ $ 1,000,00
<br />AGGREGATE $1,000,00
<br />DED J X RETENTIONS
<br />WORKERS COMPENSATION
<br />ANO EMPLOYERS' LIABILITY YIN
<br />A :ANY PROPRIETORIPARTNEWEXECUTIVE
<br />OFFICERIMEMBER EXCLUOED?
<br />iMandebs,,m NH)
<br />NIA
<br />PSWOOOI177
<br />0910112013,09101/2014
<br />!
<br />X STRTUT ER
<br />E.L. EACH ACCIDENT S 1,000,00
<br />---"---- ""'—""—"-""—"-"'
<br />E.L. DISEASE • EA EMP40YEJ S 1,000,00
<br />If a& describe Under
<br />UyySCRIPTIN OF OPERATIONS below
<br />E.L.❑IBEASE-POLICY LIMIT'S 1,000,000
<br />B Prof LiablCims Made
<br />EPL287613
<br />11108/2013
<br />11108/2014
<br />Per Claim 1,000,00
<br />B DO& $5k Per Claim
<br />I
<br />DPL287613
<br />11/0812013
<br />I
<br />11108/2014
<br />Aggregate 2,000,00
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Addelonai Remarks Schedule, may he aenchad If more space Is required)
<br />Re: All Operations
<br />The City of Santa Ana Is Additional Insured with respect to General Liability per the attached endorsement as require by wr to CgCtaly�t
<br />30 Days Notice of Cancellation with 10 Days Notice for Non-payment of Premium in accordance with She o Hayay pr sl�
<br />a1
<br />an�G Q net J
<br />CERTIFICATE HOLDER CANCELLATIORJ---/-r\ 1"', �ta11Y `''+•a
<br />ACORD 25 (2014101)
<br />©1988.2014 ACORD CORPORATION. All rights reserved.
<br />The ACORD name and logo are registered marks of ACORD
<br />{
<br />E DESCRIBED POLICIES BE CANCELLED BEFORE
<br />SHOVED ANY OF THtTOLICY
<br />THE EXPIRATION THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH PROVISIONS,
<br />The City of Santa Ana
<br />AUTHORIZED REPRESENTATIVE
<br />Attn: Michelle Walker
<br />20 Civic Center Plaza M-36
<br />P.O. Box 1988
<br />•--{-"�, �W�
<br />1^IUY,
<br />Santa Ana, CA 927021986
<br />ACORD 25 (2014101)
<br />©1988.2014 ACORD CORPORATION. All rights reserved.
<br />The ACORD name and logo are registered marks of ACORD
<br />
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