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<br />GILL&PA-01 SMITHA
<br />'4 a T ICATE OF LIABILITY INSURANCE
<br />DATE 14 V)
<br />� II�� � � HOLDER.
<br />T
<br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
<br />CERTIFICATE DOES NOT AFFIRMATI ELL,�Y,,QQ{{�� NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
<br />BELOW. THIS ��h7 'j IOFE �Rp:+j�'6E# DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
<br />REPRESENTATIV �D(�',Ef�'; ¢l`(�QITN' CERTIFICATE HOLDER.
<br />IMPORTANT: If §" ce Ificate holder is an ADDITIONAL INSURED, the 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 endorsement(s).
<br />PRODUCER License # OE67768 CONTACT
<br />NAME:
<br />IDA Insurance Services -SD PHONE 19 FAX
<br />4350 La Jolla Village Drive, Suite 900 AIC No Ext :6 ) 574-6220 AIC No (619)5]4-6288
<br />San Diego, CA 92122 aDoeless:
<br />INSURED
<br />Gillis & Panichapan Architects, Incorporated
<br />2900 Bristol St. Suite G205
<br />Costa Mesa, CA 92626 _
<br />A: RLI Insurance Company
<br />a : Atlantic Specialty Insurance
<br />INSURER F :
<br />COVERAGES CFRTIFICATF NIIMRFR- RFVISIr1N MIIMnFR.
<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 CONTRACTOR 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 />ADDLSUBR
<br />JUM
<br />MD
<br />POLICYNUMBER
<br />POLICY EFF
<br />(MMIDDA'YYYi
<br />POLICY EXP
<br />flMMflDMYYYYILIMITS
<br />oh
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />EACH OCCURRENCE $ 2,000,00
<br />CLAIMS -MADE OCCUR
<br />PSB0001119
<br />07/24/2014
<br />07/24/2015
<br />PREMISES Ea occurrence $ 1,000,00
<br />X
<br />MED EXP (Any one person) $ 10,000
<br />Contractual Llab.
<br />Dad.: $0
<br />PERSONAL &ADV INJURY $ 2,000,00
<br />X
<br />AGGREGATE LIMIT APPLIES PER:
<br />GENERAL AGGREGATE $ 4,000,00
<br />GEN'L
<br />POLICY ECT [�] LOC
<br />PRODUCTS-COMP/OPAGG $ 4,000,00
<br />$
<br />OTHER:
<br />AUTOMOBILE
<br />LIABILITY
<br />COMBINED SINGLE LIMIT $ 1,000,00
<br />Ea accident
<br />A
<br />X
<br />ANYAUTO
<br />PSA0001116
<br />06/01/2014
<br />06/01/2015
<br />BODILY INJURY (Per person) $
<br />ALL OWNED SCHEDULED
<br />AUTOS AUTOS
<br />P
<br />BODILY INJURY (Per acclenl $
<br />d )
<br />NON -OWNED
<br />HIRED AUTOS AUTOS
<br />PROPERTY DAMAGE $
<br />Parea dent
<br />X
<br />camp $1,000 X Coll $1,000
<br />$
<br />X
<br />UMBRELLA LIAB
<br />X
<br />OCCUR
<br />EACH OCCURRENCE $ 3,000,00
<br />A
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />PSE0001038
<br />07/24/2014
<br />07/24/2015
<br />AGGREGATE $ 3,000,00
<br />DED I X I RETENTION$ 0
<br />1 1$
<br />1
<br />1
<br />A
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY
<br />ANY PROPRIETORIPARTNERIEXECUTIVE YI❑N
<br />OFFICER/MEMBER EXCLUDED?
<br />(Mandatory in NH)
<br />NIA
<br />PSW0001177
<br />09/01/2013
<br />09/01/2014
<br />X PER OTH-
<br />STATUTE ER
<br />E.L. EACH ACCIDENT $ 1,000,00
<br />E.L. DISEASE - EA EMPLOYE $ 1,000,00
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE -POLICY LIMIT 1 $ 1,000,00
<br />B
<br />Prof Liab/Clms Made
<br />DPL287613
<br />11/08/2013
<br />11/08/2014
<br />Per Claim 1,000,00
<br />B
<br />Dad.: $5k Per Claim
<br />DPL287613
<br />11/08/2013
<br />11/08/2014
<br />Aggregate 2,000,00
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is 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 />.a ppr� �+ rrt �a�lYa
<br />�
<br />✓ i`
<br />CERTIFICATE HOLDER CANCFI I ATION / ZIAC —1 ISA a- " ,,,.p,wneY 7 +
<br />© 1988.2014 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD
<br />pp��55I 'a"
<br />SHOULD ANY OF THE ABOVE DESCFIIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />City of Santa Ana
<br />AUTHORIZED REPRESENTATIVE
<br />Clerk of the City Council
<br />20 Civic Center Plaza (M-30)
<br />P.O. Box 1988
<br />oh
<br />Santa Ana CA 92702
<br />© 1988.2014 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD
<br />
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