|
GILL&PA-01 ROSEM
<br />141,4c0Izv CERTIFICATE OF LIABILITY INSURANCE
<br />DATE (M
<br />5/29//201201YYY)
<br />5
<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
<br />IOA Insurance Services
<br />4350 La Jolla Village Drive
<br />Suite 900
<br />San Diego, CA 92122
<br />CONTACT
<br />NAME: Erica Wilson
<br />N
<br />PHONE FAX
<br />/C No Ext : (619) 574-6220 A/c No ; (619) 574-6288
<br />A/C,
<br />E-MAIL
<br />ADDRESS: Erica.Wilson@ioausa.com
<br />X COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE Fk] OCCUR
<br />INSURER(S) AFFORDING COVERAGE NAIC #
<br />INSURER A: RLI Insurance Company 13056
<br />07/24/2014
<br />INSURED
<br />INSURER B :Atlantic Specialty Insurance Company 27154
<br />INSURER C :
<br />Gillis & Panichapan Architects, Incorporated
<br />INSURER D:
<br />2900 Bristol St. Suite G205
<br />Costa Mesa, CA 92626
<br />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
<br />LTR
<br />TYPE OF INSURANCE
<br />ADDL
<br />UBR
<br />POLICY NUMBER
<br />EFF
<br />MM DDPOLICY/YYYY
<br />XP
<br />POLICY YYY
<br />MM/DD/Y
<br />LIMITS
<br />A
<br />X COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE Fk] OCCUR
<br />PSB0001119
<br />07/24/2014
<br />07/24/2015
<br />EACH OCCURRENCE $ 2,000,00
<br />DAMAGE TO PREMISES RENT occurrence) $ 1,000,00
<br />X Cont Liab/Sev of Int
<br />MED EXP (Any one person) $ 10,000
<br />X Ded.: $0
<br />PERSONAL & ADV INJURY $ 2,000,00
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />POLICY PRO-
<br />JECT [::] LOC
<br />GENERAL AGGREGATE $ 4,000,00
<br />PRODUCTS -COMP/OP AGG $ 4,000,000
<br />$
<br />OTHER:
<br />AUTOMOBILE
<br />LIABILITY
<br />EO aB NEDtSINGLE LIMIT $ 1,000,00
<br />AX
<br />ANY AUTO
<br />PSA0001116
<br />06/01/2015
<br />06/01/2016
<br />BODILY INJURY (Per person) $
<br />ALL OWNED SCHEDULED
<br />AUTOS AUTOS
<br />BODILY INJURY P $
<br />(Per accident
<br />( )
<br />X
<br />NON-OWNED
<br />HIRED AUTOSHAUTOS
<br />Comp/$1,000 Coll/$1,000
<br />PROPERTY DAMAGE $
<br />Per accident
<br />$
<br />X
<br />UMBRELLA LIAB
<br />X
<br />OCCUR
<br />EACH OCCURRENCE $ 3,000,000
<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 />$
<br />A
<br />WORKERS COMPENSATIONPER
<br />AND EMPLOYERS' LIABILITY
<br />ANY PROPRIETOR/PARTNER/EXECUTIVE YIN
<br />OFFICER/MEMBER EXCLUDED? ❑
<br />(Mandatory in NH)
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />NIA
<br />PSW0001177
<br />09/01/2014
<br />09/01/2015
<br />OTH-
<br />X STATUTE ER
<br />E.L. EACH ACCIDENT $ 1,000,00
<br />__...
<br />E.L. DISEASE - EA EMPLOYEE $ 1,000,000
<br />E.L. DISEASE - POLICY LIMIT $ 1,000,00
<br />B
<br />Prof Liab/Clms Made
<br />DPL386914
<br />11/08/2014
<br />11/08/2015
<br />Per Claim 2,000,000
<br />B
<br />Ded.: $5k Per Claim
<br />DPL386914
<br />11/08/2014
<br />11/08/2015
<br />Aggregate 2,000,000
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / 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 Prem>illm in a orda ce with the policy provisions.
<br />GILLIS & PANICHAPAN ARCHITECTS, INC. REVIEWED BY: EUNICE HEREDIA (PG 1 OF 2)
<br />CERTIFICATE HOLDER CANCELLATION
<br />ACORD 25 (2014/01)
<br />©1988-2014 ACORD CORPORATION. All rights reserved.
<br />The ACORD name and logo are registered marks of ACORD
<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 />City of Santa Ana
<br />Clerk of the City Council
<br />AUTHORIZED REPRESENTATIVE
<br />20 Civic Center Plaza (M-30)
<br />P.O. Box 1988
<br />Santa Ana CA 92702
<br />ACORD 25 (2014/01)
<br />©1988-2014 ACORD CORPORATION. All rights reserved.
<br />The ACORD name and logo are registered marks of ACORD
<br />
|