|
-t GILL&PA-01 ROSEM
<br />f'I� R� CERTIFICATE OF LIABILITY INSURANCE DAT/2612DIYI'YY)
<br />7rzs/zo1 z
<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(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 # OE67768 NAMEACT Ali Smith
<br />ICA Insurance Services - SD PHONEFAX
<br />4350 La Jolla Village Drive, Suite 900 CAIC, No, E.tl: (619) 574-6220 (AIC, No): (619) 574-6288
<br />San Diego, CA 92122 no aRess: ali.smith@ioausa.com
<br />INSURER(S) AFFORDING COVERAGE NAIC Y
<br />INSURERA: RLI Insurance Company 13056
<br />INSURED INSURERS: One Beacon America Insurance Company 20621
<br />Gillis & Panichapan Architects, Incorporated INSURER C:
<br />2900 Bristol St. Suite G206 INSURER D:
<br />Costa Mesa, CA 92626 INSURER E:
<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 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 - - - -ADOL SUSR POLICY EFF POLICY EXP
<br />LTR TYPE OF INSURANCE INSR WVD POLICYNUMBER (MMIDDIYYYY) (MMIDD(YYYY) LIMITS
<br />GENERAL LIABILITY EACH OCCURRENCE E 1,000,000
<br />A X COMMERCIAL GENERAL LIABILITY X PSBOOO1119 7/24/2012 7124/2013 DAMAGE TO RENTED 1,000,000
<br />_ PREMISES (Ea occurrence) $
<br />CLAIMS -MADE X OCCUR MED EXP (Any one person) S 10,000
<br />X Contractual Llab. PERSONAL 8 ADV INJURY $ 1,000,000
<br />GENERAL AGGREGATE $ 2,000,000
<br />GENL AGGREGATE LIMITAPPLIES PER PRODUCTS - COMPlOP AGG $ 2,000,000
<br />POLICY X PRO -
<br />POLICY LOC S
<br />JO-
<br />AUTOMOBILELIABILITY COMBINED SINGLE LIMIT 1,000,000
<br />(Ea acrid -1) E
<br />A X ANYAUTO PSA0001116 6/1/2012 611/2013 BODILY INJURY (Per person) S
<br />ALL OWNED SCHEDULED tl
<br />INJURY BODILY INJUPer accienl
<br />AUTOS AUTOS ( ) $
<br />NON OWNED PROPERTY DAMAGE
<br />HIRED AUTOS AUTOS (Per accident $
<br />S
<br />X UMBRELLA LIAR X OCCUR EACH OCCURRENCE S 1,000,000
<br />A EXCESS LIAO CLAIMS -MAGE PSE0001038 7/24/2011 7/24/2012 AGGREGATE $ 1,000,000
<br />_ DED X RETENTIONS $
<br />WORKERS COMPENSATION X WC STATU- OTH-
<br />AND EMPLOYERS' LIABILITY YIN TORY LIMITS ER _
<br />A OF EXCLUDEIE ECUTIVE NIA PSW0001177 9/1/2012 9/1/2013 EL EACH ACCIDENT S 1,000,000
<br />(Mandatory in NH) E L DISEASE - FA EMPLOYEE $ 1,DOO,000
<br />If yes describe untler
<br />DESCRIPTION OF OPERATIONS beIow E.L. DISEASE -POLICY LIMIT S 1,000,000
<br />B Prof LIab/Clms Made DPL103311 11/8/2011 11/8/2012 Per Claim 1,000,000
<br />B Ded.: $5k Per Claim OPL103311 11/8/2011 1118/2012 Aggregate 2,000,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD IOI. Additional Remarks Schadula, If more apace la ragWndl
<br />Re: All Operations
<br />The City of Santa Ana Is Additional Insured with respect to General Liability perthe attached endorsement as required by written contract.
<br />30 Days Notice of Cancellation with 10 Days Notice for Non -Payment of Premium in accordance with the policy provisions.
<br />A.PPRU'V :l ) FS.i 1'(1) 1'( RIM
<br />CERTIFICATE HOLDER / CANCELLATION
<br />I_31,t J Jl.l, 'iccdy SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />Aa ,,Iaor City Al.lornc% THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />The City of Santa Ana
<br />Attn: Michelle Walker AUTHORIZED REPRESENTATIVE
<br />20 Civic Center Plaza M-36
<br />P.O. Box 1988
<br />Santa Ana, CA 92702-1988
<br />©1988-2010 ACORD CORPORATION. All rights reserved.
<br />ACORO 25 (2010/05) The ACORD name and logo are registered marks of ACORD
<br />
|