|
A r%^Mr%
<br />CERTIFICATE OF LIABILITY INSURANCE
<br />DATE(MM'DD[YYYY)
<br />11/04/2010
<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 DR 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 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
<br />CONTACT NAME: Sara Cabral
<br />Insurance Office of America, Inc.
<br />P,a"!c"N ,EXtr 619.574.6220 1WC No)_619.574.6288
<br />- —
<br />DBA IDA Insurance Services
<br />E-MAIL
<br />1775 Hancock Street, Ste. 180
<br />ADDRESS:
<br />PRODUCER
<br />San Diego, CA 92110
<br />CUSTOMER ID #:
<br />INSURER(S) AFFORDING COVERAGE
<br />NAIC #
<br />--------
<br />INSURED
<br />--- _
<br />INSURER A: Travelers Prop Cas Co of Amer
<br />25674
<br />Gillis & Panichapan Architects, Incorporated
<br />INSURER B: OneBeacon America Ins Co
<br />_
<br />20621
<br />2900 Bristol St. Suite G205
<br />INSURER C
<br />_
<br />Costa Mesa, CA 92626
<br />INSURERD:
<br />INSURER E.
<br />INSURER F :
<br />lR�l'Iy rl�l wazo o 1=[WIVNQR`fs Wd zi=.'ail VWARRW� WAVI.\NIllh'l A"IdEVA T.l-1y
<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 N S R
<br />SUBR
<br />WVD
<br />POLICY NUMBER
<br />POLICY EFF
<br />MMlDD'YYY
<br />POLICY EXP
<br />MMlDD/YYYY
<br />LIMITS
<br />GENERAL LIABILITY
<br />6802841L495, 07/24/2010
<br />07/24/2011
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />X COMMERCIAL GENERAL LIABILITY
<br />DAMAGE TO RENTED
<br />PREMISES (Ea occurrence]
<br />$ 300,000
<br />Jl
<br />MED EXP (Any one person)
<br />$ 5,000
<br />CLAIMS -MADE FX J OCCUR
<br />PERSONAL & ADV INJURY
<br />1,000,000
<br />__$
<br />GENERAL AGGREGATE
<br />$ 2,000,000
<br />GENT AGGREGATE LIMIT APPLIES PER
<br />PRODUCTS-- COMPIOP AGG
<br />-
<br />$ 2,000,000
<br />POLICY X JECT PRO- LOC
<br />-
<br />$
<br />AUTOMOBILE
<br />LIABILITY
<br />BA9193L09i.01/11/2011
<br />01/11/2012
<br />COMBINED SINGLE LIMIT
<br />$
<br />X
<br />ANY AUTO
<br />(Ea accident)
<br />1,000,000
<br />BODILY INJURY (Per person)
<br />$
<br />-
<br />ALL OWNED AUTOS
<br />b >��} t%y 1 ��
<br />� � -" I '- (
<br />BODILY INJURY (Per accident)
<br />$
<br />A
<br />SCHEDULED AUTOS
<br />HIRED AUTOS
<br />!
<br />� '
<br />/y% /
<br />�----�
<br />PROPERTY DAMAGE
<br />(Per accident)
<br />$
<br />-
<br />NON -OWNED AUTOS
<br />-- _-_
<br />Lali T,
<br />$
<br />$
<br />UMBRELLA LIAB J�XOCCUR
<br />CUP6785Y338
<br />07/24/2010
<br />07/24/2011
<br />EACH OCCURRENCE
<br />$ 1, 000, 000
<br />AGGREGATE
<br />$ 1,000,000
<br />A
<br />EXCESS
<br />CLAIMS -MADE
<br />DEDUCTIBLE
<br />X
<br />RETENTION $
<br />$
<br />WORKERS COMPENSATION
<br />406030061
<br />09/01/2010
<br />09/01/2011
<br />X WC STATU- OTH-
<br />AND EMPLOYERS' LIABILITY Y 1 N
<br />TORY LIMITS I I ER__
<br />E.L. EACH ACCIDENT
<br />$ 1,000,000
<br />B
<br />ANY PROPRIETORIPARTNERIEXECUTIVE
<br />OFFICER/MEMBER EXCLUDED?
<br />N/A
<br />_ _
<br />E.L. DISEASE - EA EMPLOYEE
<br />--
<br />$ 1, 000, 000
<br />(Mandatory In NH)
<br />If yes, describe under
<br />-
<br />E.L. DISEASE - POLICY LIMIT
<br />_—
<br />$ 1,000,000
<br />DESCRIPTION OF OPERATIONS below
<br />B
<br />Professional Liability
<br />DPL03361
<br />11/08/2010
<br />11/08/2011
<br />$1,000,000
<br />Per Claim
<br />LAIMS MADE
<br />$5,000 DEDUCTIBLE
<br />$2,000,000 Aggregate
<br />DESCRIPTION OF OPERATIONS ! LOCATIONS ! VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required)
<br />e: All Operations of the Named Insured
<br />The City of Santa Ana is additional insured as respects general liability per the attached endorsement.
<br />CERTIFICATE HOLDER reklrFl I ATInkl
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />The City of Santa Ana ACCORDANCE WITH THE POLICY PROVISIONS.
<br />Attn: Michelle Walker
<br />20 Civic Center Plaza M-36 AUTHORIZED REPRESENTATIVE 7—
<br />PO Box 1988
<br />Sa to Ana, CA 92702-1988 Kelly Howell ENUTE
<br />v 1905-2009 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD
<br />
|