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GILL&PA-01 ROSEMI
<br />�0..
<br />CERTIFICATE OF LIABILITY INSURANCE
<br />DATE (MM;oDPYYYY)
<br />OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
<br />111412014
<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(lies) 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 '# OE67768
<br />NAME CT Erica V41iISQn
<br />IOA Insurance Services -SD
<br />4350 La Jolla Village Drive, Suite 900
<br />PHO__.................tµax . ....
<br />NE
<br />JNC Ng Ext4:.(S19) 574-1224 11 ... A,� �,,�: (619) 574-6268
<br />San Diego, CA 92122
<br />E-MAIL
<br />ADDRESS: Erica.I� ilson@ioausa.com
<br />MED EXP (Any one person) .,,.$
<br />INSURER(S) AFFORDING. COVERAGE NAIL #
<br />X Ded.::Q.......
<br />INSURER A:RLI Insurance Company 13056
<br />INSURED
<br />INSURER B: Atlantic Specialty Insurance Company ..
<br />p _il_ p y ..... 27154
<br />Gillis & Panichapan Architects, Incorporated
<br />INsuRERc:
<br />2900 Bristol St. Suite G205
<br />INSURER D :
<br />Costa Mesa, CA 92626
<br />OTHER:
<br />$
<br />INSURER E
<br />AUTOMOBILE LIABILITY
<br />INSURER F:
<br />COVERAGES CERTIFICATE NUMBER: RFVISIt]M N111MIl R°
<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
<br />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
<br />THE TERMS,
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />INSR-------aDOL�s(IhR ..............
<br />LTR TYPE OF INSURANCE. I
<br />D D,' POLICY
<br />---.. - __..—._
<br />POLICY EFF POLICY EXi',,....
<br />MMIDDfYYYY MMIDDPi'YYY LIMITS
<br />......................... .._.
<br />A, X i COMMERCIAL GENERAL LIABILITY
<br />EACH OCCURRENCE $
<br />2,000,00
<br />CLAIMS -MADE X ,OCCUR X PSB0001119
<br />0712412014 07124/2015 OAMAGEICiTzEl
<br />_PREM ISIS(Eaoccicuence) 5
<br />1,000,00
<br />X7 Cont Liab/Sev of Int
<br />MED EXP (Any one person) .,,.$
<br />10,000
<br />X Ded.::Q.......
<br />PERSONAL & ADV INJURY $
<br />..- 2,000,000
<br />R. I
<br />GENT AGGREG��jAf,�TEAPPLIES POEC
<br />GENERAL AGGREGATE , $
<br />4,000,000
<br />POLICY JECT
<br />I 1 PRODUCTS CQMPdOPAGG $
<br />4,000,00
<br />OTHER:
<br />$
<br />AUTOMOBILE LIABILITY
<br />COMBINED SINGLE LIMIT $
<br />1,000,000
<br />ANY AUTO IPSA0001116
<br />_�Ea accident)
<br />06/0112014 0610112015 BODILY INJURY (Per person) � $
<br />ALL OWNED SCHEDULED
<br />AUTOS AUTOS
<br />BODILY INJURY Per accident) $
<br />i � ( i'
<br />NON -OWNED
<br />AUTOSAUTOS
<br />f PROPERTY AMAGE i $
<br />(Per accident)_________
<br />�HIRED
<br />X Comp $1Col] $1,060
<br />-D
<br />_..._.
<br />UMBRELLA LAB OCCUR i'
<br />�
<br />EACH OCCURRENCE $
<br />3,000,000
<br />A ExCESS uAa CLAIMS -I IPSE0001038
<br />07124/2014 0712412015 AGGREGATE $
<br />3,000,00
<br />DED I X 1 RETENTION $ 0
<br />—
<br />WORKERS COMPENSATION
<br />PER 0TH-,
<br />1 X STATUTE r
<br />!AND EMPLOYERS" LIABILITYYIN
<br />ERA
<br />1 ,
<br />ANY
<br />N/AI PSWQO'01177
<br />0910112014 091011/2015 ENT
<br />f�sCdQ�bM H�tEXCLUDEDXECUTIVE
<br />i -.i''..,
<br />rEL DtlSEASE�EAEMPLOYEE $
<br />1,000,000
<br />underI
<br />DESCRIPTION OF OPERATIONS below
<br />� E . DISEASE -POLICY LIMIT '.... $
<br />1,000,00
<br />BProf Liab/Clms Made DPL386914
<br />11108/2014 ! 11/08/2015 Per Claim
<br />2,000,00
<br />B Ded.: $5k Per Claim OPL386914
<br />11108/2014 11/0812015 Aggregate
<br />2,000,000
<br />DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached 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 required by written contract.
<br />30 Days Notice of Cancellation with 10 Days Notice for Non -Payment of Premium
<br />in accordance with the policy provisions.
<br />,
<br />r , r
<br />,
<br />4 J
<br />I
<br />r.
<br />- tin . a " / ii APi1,..l I I'UIV�
<br />The City of Santa Ana
<br />Attu: MielaetleWatlaer
<br />20 Civic Center Plaza M-36
<br />P.O. Box 1988
<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 PROVISIONS.
<br />AUTHORIZED REPRESENTATIVE
<br />1988.2014 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD
<br />
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