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ACORDM CERTIFICATE OF LIABILITY INSURANCE
<br />08/19jzo10
<br />PRODUCER (619) 574-6220 FAX (619) 574-6288
<br />Insurance Office of America, Inc.
<br />DBA IOA Insurance Services
<br />1775 Hancock Street, Ste. 180
<br />San Diego, CA 92110
<br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
<br />ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
<br />HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
<br />ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
<br />INSURERS AFFORDING COVERAGE NAIC #
<br />INSURED Gillis & Panichapan Architect , Incorporated
<br />2900 Bristol St. Suite G205
<br />Costa Mesa, CA 92626 -,_ l7Z
<br />{ V
<br />INSURER A: Travelers PK Co. of America 25674
<br />INSURERB: OneBeacon America Ins. Co.
<br />INSURERc: Ace American Ins. Co. 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. NOTWITHSTANDING
<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 />INSRDDT
<br />.LTRGENERAL
<br />*30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
<br />TYPE OF INSURANCE
<br />POLICY NUMBER
<br />POLICY EFFECTIVE
<br />POLICY EXPIRATION
<br />LIMITS
<br />AUTHORIZED REPRESENTATIVE /
<br />Oil
<br />LIABILITY
<br />6802841L495
<br />07/24/2010
<br />07/24/2011
<br />EACH OCCURRENCE $ 1,000,000
<br />X COMMERCIAL GENERAL LIABILITY
<br />DAMAGE TO RENTED $ 300,000
<br />CLAIMS MADE FX] OCCUR
<br />MED EXP (Any one person) $ 10,000
<br />A
<br />PERSONAL & ADV INJURY $ 1,000,000
<br />GENERAL AGGREGATE $ 2,000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />PRODUCTS - COMP/OP AGG $ 2,000,000
<br />POLICY X PJE& RO LOC
<br />AUTOMOBILE LIABILITY
<br />X ANY AUTO
<br />BA9193 LO91
<br />01/11/2010
<br />01/11/2011
<br />COMBINED SINGLE LIMIT
<br />(Ea accident) $ 1,000,000 ,000,00
<br />BODILY INJURY $
<br />person)
<br />A
<br />ALL OWNED AUTOS
<br />SCHEDULED AUTOS
<br />(Per
<br />A ��Ti , • r A
<br />)
<br />) f, TO
<br />�iJ�
<br />O�1
<br />BODILY INJURY
<br />(Per accident) $
<br />HIRED AUTOS
<br />NON -OWNED AUTOS
<br />t
<br />PROPERTY DAMAGE
<br />(Per accident) $
<br />_ a u
<br />a Stitt S , �. « ,
<br />GARAGE LIABILITY
<br />AUTO ONLY - EA ACCIDENT $
<br />ANY AUTO
<br />OTHER THAN EA ACC $
<br />AUTO ONLY: AGG $
<br />EXCESS/UMBRELLA LIABILITY
<br />_X1 OCCUR F] CLAIMS MADE
<br />CUP6785Y338
<br />07/24/2010
<br />07/24/2011
<br />EACH OCCURRENCE $ 1,000,000
<br />AGGREGATE $ 1,000,000
<br />A
<br />$
<br />$
<br />DEDUCTIBLE
<br />$
<br />RETENTION $
<br />WORKERS COMPENSATION AND
<br />406030061
<br />09/01/2010
<br />09/01/2011
<br />X 11TwQcRysTA,,1uTa7OTH-
<br />T___1EMPLOYERS'
<br />B
<br />LIABILITY
<br />ANY PROPRIETOR/PARTNER/EXECUTIVE
<br />OFFICER/MEMBER EXCLUDED?
<br />If yes, describe under
<br />SPECIAL PROVISIONS below
<br />E.L. EACH OCCIDENT $ 1 , 000 , 000
<br />E.L. DISEASE - EA EMPLOYEE $ 1,000,000
<br />E.L. DISEASE - POLICY LIMIT 1 $ 1,000,000
<br />C
<br />ro essional Liability
<br />laims Made
<br />623638319004
<br />11/08/2009
<br />11/08/2010
<br />$1,000,000 each occurence
<br />$2,000,000 aggregate
<br />$5,000 deductible
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS
<br />Re: All Operations of the Named Insured
<br />he City of Santa Ana is additional insured as respects general liability per the attached endorsement.
<br />",10 Days Notice of Cancellation Applies for Non -Payment of Premium.
<br />rFRTIFICATF wrm IIFR rAAIrGI I ATIr%KI
<br />ACORD 25 (2001/08) ©ACORD CORPORATION 1988
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
<br />The City of Santa Ana
<br />EXPIRATION DkTE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL
<br />Attn • Michelle Walker
<br />*30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
<br />20 Civic Center Plaza M-36
<br />BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY
<br />PO Box 1988
<br />OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES.
<br />Santa Ana, CA 92702-1988
<br />AUTHORIZED REPRESENTATIVE /
<br />Oil
<br />Kelly Howell CABRAS
<br />ACORD 25 (2001/08) ©ACORD CORPORATION 1988
<br />
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