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i' <br />AORM CERTIFICATE OF LIABILITY INSURANCE ]:!DATE (MM/DDlY0, <br />PRODUCER (619)574-6220 FAX (619)574-6288 11/04/2009 <br />THIS CERTIFICATE IS ISSUED ASA MATTER OF INFORMATION <br />Insurance Office of America, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br />DBA IOA Insurance Services HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br />1775 Hancock Street, Ste. 180 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br />San Diego, CA 92110 INSURERS AFFORDING COVERAGE NAIC # <br />INSURED Gillis & Pani chapan Architects, Incorporated INSURER A: Travelers P&C Co. of America 25674 <br />2900 Bristol St. Suite 6205 INSURERB: OneBeacon America Ins. Co. <br />Costa Mesa, CA 92626 INSURERc: Ace American Ins. Co. <br />22667 <br />INSURER D: <br />INSURER E: <br />COVERAGES <br />THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDIN( <br />ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR <br />MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH <br />POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />INSR DD' TYPE OF INSURANCEPOLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION <br />GENERAL LIABILITY LIMITS <br />X COMMERCIAL GENERAL LIABILITY <br />680284IL495 07/24/2009 07/24/2010 EACH OCCURRENCE $ 1,000,0C <br />DAMAGE TO RENTED <br />CLAIMS MADE [ fl OCCUR $ 300,0C <br />A <br />MED EXP (Any one person) $ 1010113 <br />PERSONAL & ADV INJURY $ 11 OOO, OO <br />GENERAL AGGREGATE $ 2,000,00 <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />POLICYMX JECOT- LOC PRODUCTS - COMP/OP AGG $ 2,000,00 <br />AUTOMOBILE LIABILITY BA9193LO91 01/11/2009 01/11/2010 <br />X ANY AUTO COMBINED SINGLE LIMIT $ <br />ALL OWNED AUTOS (Ea accident) 1,000,00 <br />SCHEDULED AUTOS BODILY INJURY <br />A a (Per person) $ <br />HIRED AUTOS R- C)��,i <br />Y .r <br />NON -OWNED AUTOS - BODILY INJURY $ <br />(Per accident) <br />PROPERTY DAMAGE $ <br />(Per accident) <br />GARAGE LIABILITY <br />1- - ,�: AUTO ONLY - EA ACCIDENT <br />ANY AUTO � ". , t i c� ' Lc tSZ $ <br />OTHER THAN EA ACC $ <br />AUTO ONLY: AGG $ <br />EXCESS/UMBRELLA LIABILITY CUP6785Y338 07/24/2009 07/24/2010 EACH OCCURRENCE <br />X OCCUR ❑ CLAIMS MADE $ 1 <br />A AGGREGATE $ 1! 1 000 OOC <br />DEDUCTIBLE $ <br />RETENTION $ $ <br />WORKERS COMPENSATION AND 406030061 09/01/2009 09/01/2010 X $ <br />EMPLOYERS' LIABILITY WC I IMIT4 OTH- <br />B ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ 11000,00 <br />OFFICER/MEMBER EXCLUDED? <br />If yes, describe under E.L. DISEASE - EA EMPLOYE $ 1,000,00 <br />SPECIAL PROVISIONS below <br />EL <br />C roressional Liability <br />623638319004 11/08/2009 11/08/2010 $1,000,000. DISEASE - POLICY LIeach occurence00 <br />laims Made $2,000,000 aggregate <br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS $5,000 deductible <br />e: All Operations of the Named Insured <br />roof of Insurance <br />10 Days Notice of Cancellation Applies for Non -Payment of Premium. <br />CERTIFICATE HOLDER CAKII Mi I AT1^­ <br />City of Santa Ana <br />Clerk of the City Council <br />20 Civic Center Plaza (M-30) <br />PO Box 1988 <br />Santa Ana, CA 92702 <br />AGORD 25 (2601/08) <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE <br />EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL <br />30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLIER NAMED TO THE LEFT, <br />BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY <br />OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. <br />AUTHOR !ED REPRESENTATIVE <br />Kelly Howell/CABRAS9)( <br />©ACORD CORPORATION 1988 <br />