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GILL&PA-01 ROSEM <br />CERTIFICATE OF LIABILITY INSURANCE DA11`14/2013YYl <br />_ _ <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 />.. ......po --_.._....._._ ._._.... <br />IMPORTANT: If the certificate holder is an ADDITIONAL INSURED_, the_ -1 policy(les) 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 andorsement(s). <br />PRODUCER -License # OE67768 <br />IDA Insurance Services -SO <br />4360 La Jolla Village Drive, Suite 900 <br />San Diego, CA 92122 <br />__-- INSURER(S)AFFORDING COVERAGE NAICR <br />INSURER A:RLI Insurance Company 13056 <br />INSURED INSURER a : Atlantic Specialty Insurance Company . 127154 <br />IS <br />Gillis & Panichapan Architects, Incorporated <br />2900 Bristol St. Suite G205 <br />Costa Mesa, CA 92626 <br />__DDC/__ <br />MAY BE ISSUED OR MAY <br />AND CONDITIONS OF SUCH <br />117411111 <br />GENERAL LIABILITY <br />A X COMMERCIAL GENERAL LIABILITY X P.SB0001119 <br />CLAIMS MADEI_X OCCUR � <br />X I Contractual Liab. <br />LIMIT APPLIES PER: <br />AUTOMOBILE LIABILITY <br />A X ANYAUTO .PSA0001116 <br />i ALLOWNED ( 'SCHEDULED <br />AUTOSAUTOS <br />HIRED AUTOS .i NON -OWNED <br />AUTOS <br />BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR TF <br />DNDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPE( <br />AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TC <br />kY HAVE BEEN REDUCED BY PAID CLAIMS. <br />.......------ -TOLICYEFP-PDLICY€XP---'_._._._.__.. _...... ._....__._._. <br />JMBER I1AMI)nIYPW1 nmminn t LIMITS <br />7/2412013 7/2412014 <br />6/1/2013 1 611/2014 <br />7/24/2013 7124r2014 <br />PERSONAL&ADVINJURY ly <br />GENERALAGGREGATE $ <br />PRODUCTS-COMP/OPAGG ,$ <br />CO ED IN LE L MI <br />(Eaacedenl)„ .. ,I_$ <br />BODILY INJURY (Per person) 1 $ <br />BODILY <br />..INJUi.__ .....L.... <br />RY (Per accitlentj : $ <br />(PER AC ACCIDENT),, ....i,$ <br />EACH OCCURRENCE i$ <br />X <br />9/1/2013 9/112014 E. <br />11/8/2013 1102014 Per Claim <br />1118/2013 111812014 Aggrogatl <br />...._.__. ____.�. _._ _.. ............._ ... ........_......._----- - '­­-.­.­.­ ._....__._....... _..__ _...._.... _.. <br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, AdditlonaI Remarks Schedule if more space ,s 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 in accordance with the policy provisions. <br />APPROVED A5 TO FORM <br />CERTIFICATE HOLDER _ <br />Laura Stptt 3heedy <br />Assistant City Attorney <br />The City of Santa Ana <br />Attn: Michelle Walker <br />20 Civic Center Plaza M-36 <br />P.O. Box 1988 <br />92702-1988 <br />CANCELLATION _ <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 />_f." AAJJUZ, 4asa <br />©1988-2010 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2010106) The ACORD name and logo are registered marks of ACORD <br />X UMBRaLLAL1AB I Xj OCCUR <br />AEXCESS <br />LIAB CLAIM"ADE <br />PSE0001038 <br />_.__.... <br />OED X RETENTION$ <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY <br />V(N. <br />A <br />ANY <br />!.PSW0001177 <br />OFFICERIMEMBERIEACLUOED9ECUTIVE <br />N/A <br />(Mandatory in NH) <br />If yes describe under <br />DESCRIPTION Or OPERATIONS below <br />- <br />B <br />Prof Liab/Clms Made <br />DPL287613 <br />B <br />!Dad.: $51k Per Claim <br />DPL287613 <br />BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR TF <br />DNDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPE( <br />AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TC <br />kY HAVE BEEN REDUCED BY PAID CLAIMS. <br />.......------ -TOLICYEFP-PDLICY€XP---'_._._._.__.. _...... ._....__._._. <br />JMBER I1AMI)nIYPW1 nmminn t LIMITS <br />7/2412013 7/2412014 <br />6/1/2013 1 611/2014 <br />7/24/2013 7124r2014 <br />PERSONAL&ADVINJURY ly <br />GENERALAGGREGATE $ <br />PRODUCTS-COMP/OPAGG ,$ <br />CO ED IN LE L MI <br />(Eaacedenl)„ .. ,I_$ <br />BODILY INJURY (Per person) 1 $ <br />BODILY <br />..INJUi.__ .....L.... <br />RY (Per accitlentj : $ <br />(PER AC ACCIDENT),, ....i,$ <br />EACH OCCURRENCE i$ <br />X <br />9/1/2013 9/112014 E. <br />11/8/2013 1102014 Per Claim <br />1118/2013 111812014 Aggrogatl <br />...._.__. ____.�. _._ _.. ............._ ... ........_......._----- - '­­-.­.­.­ ._....__._....... _..__ _...._.... _.. <br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, AdditlonaI Remarks Schedule if more space ,s 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 in accordance with the policy provisions. <br />APPROVED A5 TO FORM <br />CERTIFICATE HOLDER _ <br />Laura Stptt 3heedy <br />Assistant City Attorney <br />The City of Santa Ana <br />Attn: Michelle Walker <br />20 Civic Center Plaza M-36 <br />P.O. Box 1988 <br />92702-1988 <br />CANCELLATION _ <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 />_f." AAJJUZ, 4asa <br />©1988-2010 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2010106) The ACORD name and logo are registered marks of ACORD <br />