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<br />GILL.&PA-01 SMITHA
<br />CERTIFICATE OF LIABILITY INSURANCE
<br />8/1212014
<br />THIS CERTIFICATE 1S 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 tons and conditions of the policy, Certain policies may require an endorsement. A statement an this certificate does not confer rights to the
<br />certificate holder in lieu of such endorsement(s).
<br />PRODUCER License # OE67768
<br />IDA Insurance Services -SD
<br />4550 La Jolla Village Drive, Suite 900
<br />San Diego, CA 92122
<br />CONTACT —'-"u
<br />NAME:
<br />PHONE .619) 574.6220 rAX NE (619 574.8208
<br />fC.a E [AICJ: }
<br />E-MAIL
<br />F INSURERS) AFFORDING COVERAGE
<br />NAICC
<br />CLAIMS•MADE DenuR )
<br />IN9URERA:RLIInsurance Compan
<br />110056
<br />0712412015, pREhUAMI IU �gGLrre Esy $ 1,000,000
<br />INSURED
<br />INSURER a:Atlantic Specialty Insurance Company
<br />127154
<br />INSURERC:
<br />MEoeXI>iAnyane ae scnl ,S 10,000
<br />I
<br />Gillis& Panichapan Architects, Incorporated
<br />INSVRER a:
<br />I
<br />2900 Bristol St. Suite G205
<br />Costa Mesa, CA 92625
<br />ENSURER E:
<br />:__INSURER
<br />GEN'LAGGREGATE LIMIT APPLIES PER:
<br />--
<br />INSURER F
<br />III
<br />4
<br />r
<br />COVERAGES CERTIFICATE NUMBER, RFVIRIf1N NUMRFR-
<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 DOCUMENTWITH RESPECTTO WHICHTHI$
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUSJECTTOALLTHE TERMS,
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS..
<br />Iffu
<br />YR•
<br />TYPE OF INSURANCE
<br />POLICY NUMaER
<br />POLICY OFF
<br />OOIYYYYM
<br />1 PCLCYEXP
<br />DO YY)I LIMITS
<br />A
<br />x I COMMERCIAL GENERAL LIABILITY
<br />AUTHORIZED REPRESENTATIVE
<br />Clerk Of the City Council
<br />EAChI OCCVRRENCE 15 – 2,000.00
<br />^
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<br />I
<br />CLAIMS•MADE DenuR )
<br />�PSB0001tt9
<br />107124/2014
<br />0712412015, pREhUAMI IU �gGLrre Esy $ 1,000,000
<br />X'ContraCkual Lisp.
<br />MEoeXI>iAnyane ae scnl ,S 10,000
<br />I
<br />X) DBL.: —$01
<br />I
<br />) PERSONAL A AOV INJURY i 3 2,1300 ,000
<br />GEN'LAGGREGATE LIMIT APPLIES PER:
<br />III
<br />4
<br />r
<br />I GENERALAGORECATE i$ 4,000,00
<br />POLICY 1K JET LOC.
<br />i i
<br />i
<br />I
<br />I PRODUCTS '• COMPIOP AGO' 3 4,000,00
<br />) AUTOMOBILE 0AINUTY
<br />I j i
<br />c Mal • sWOL L I
<br />LLEEa at eani 11 1,000,00
<br />A
<br />ANYAUTO
<br />1 i (PSA00011 IS(
<br />08101f2014
<br />06/0112015; eODILYINJURRRYIPI"IsMonl S
<br />I ALL OWNED SCHEDULED.
<br />„_I AUTOS AUt05
<br />!
<br />IBODILY INJURV (Paracid nq $
<br />I NON -OWNED
<br />a HIREDAUTOE I. AUTOS
<br />I pROpYR(Y DA1AtTE
<br />Pr acc One
<br />�X Comp61,000 X Goh $1,0GO
<br />)
<br />13
<br />i $
<br />lr UMBRELLA LIAR (i. j OCCUR
<br />_
<br />) i
<br />'
<br />1 EACH OCCURRENCE $ 8,000,00
<br />A
<br />- t EXCESS LIAR DL4IM6MAOE
<br />' (PSE0004030 I
<br />p7f24/2014i
<br />07!24(2095 AGGREG117E $ 31000,00
<br />DEL) I X= RETENT'ON$. OI
<br />WORKERS COM PONBATI O9
<br />!t I
<br />AND EMPLOYERS'LIABILOY YIN
<br />STT RA
<br />A
<br />ANY PRGPPIETORiPARTNEPoMcUTIVE ❑INiA
<br />OFFICERIMEMSER EXCLUOSI
<br />PSW0001177
<br />0910112013109M112014'14
<br />EL EACH ACCIDENT `g 1,000,00
<br />(Mandatory In NH)
<br />EL DISEASE EAAEIAPLOYE S 1,000,00.
<br />Ifyyoa6. dO8E4ibe bill
<br />OESCRPTION OPOPEFATION D.Imy
<br />ELI of LIMIT $ 1,000.,00
<br />B
<br />Prof LiablCims Made
<br />IDPL287615
<br />'11100!2013)
<br />1110812014(Per Claim 11000,00
<br />B �Ded.;
<br />$Sk Por Claim
<br />DPL287693
<br />� 11108(2 013 1
<br />1 910 812014 jAggragate 2,000,00
<br />DESCRIPTION OF OPERATIONS 1 LOCATIONS i VEHICLES (ACtlftD tel. Adtlltfonal Remarks Schedula, may an aeanM1etl if sore 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 />��5.i
<br />CERTIFICATE HOLDER CANCELLATION Cnev "
<br />SHOULD ANY OFTHE ABOVE DESCRIBED 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 Cantor Plaza (M•30)
<br />P.O.
<br />P.Q. Bax 1958
<br />^
<br />—T-
<br />I
<br />Santa Ana CA 92702
<br />p 1980-2014 ACORO CORPORATION. All rights reserved.
<br />ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD
<br />
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