|
CSGCONS-01 JPERRY3
<br /> A��Rv CERTIFICATE OF LIABILITY INSURANCE DATOIYYYY)
<br /> 1 21612rsrea24
<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 have ADDITIONAL INSURED provisions or be endorsed.
<br /> If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on
<br /> this certificate does not confer rights to the certificate holder in lieu of such end©rsement(s).
<br /> PRODUCER License#OC36861 CONTACT Julia Perry
<br /> Alliant Insurance Services,Inc. PHONE FAX
<br /> 560 Mission St 6th FI (AIC,No,Ext):(925)280 4671 (A/C,plo):
<br /> San Francisco,CA 94105 E-MAIL oRESS:Julia.Perry@alliant.com
<br /> �talliant.Com
<br /> o
<br /> INSURER S AFFORDI_NG COVERAGE NAIL
<br /> INSURER A:United States Fire Insurance Company
<br /> INSURED INSURER B:Nationwide Affinity Insurance Company of America 26093
<br /> CSG Consultants,Inc. INSURERC:North River Insurance_Com an 21105
<br /> 550 Pilgrim Drive INSURERo:United States Fire Insurance Company 21113
<br /> Foster City,CA 94404 INSURER E:PaCIfIC Insurance Company, Limited 10046
<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 /> ILT
<br /> LTRNSR TYPE OF INSURANCE ADDLINSD ISUBp POLICY NUMBER POLICY EFF POLICYMD LIMITS
<br /> A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE 5 1,000,000
<br /> CLAIMS-MADE �X OCCUR X 5432352732 12/412024 12/412025 DAEMISES?a occu D renre) $ 300,000
<br /> MED EXP(Any oneperson) 5 10,000
<br /> PERSONAL&ADV INJURY $ 1,000,000
<br /> GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000
<br /> POLICY❑JJE T 1XI LOC PRODUCTS-COMPJOPAGG $ 2,000,000
<br /> OTHER
<br /> B AUTOMOBILE LIABILITY COMBINEDSINGLELIMIT 1,000,000
<br /> Ea accident $
<br /> X ANY AUTO X 72APBO10186 1214/2024 1214/2025 BODILY INJURY Perperson) $
<br /> OWNED SCHEDULED --
<br /> AUTOS ONLY AUTOS BODILY INJURY Per accident)$ _
<br /> HIRED NON-OWNED PROPERTY DAMAGE
<br /> AUTOS ONLY AUTOS ONLY Pereccident $
<br /> C X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000
<br /> EXCESS LIAB CLAIMS-MADE; 5821248132 12/412024 121412025 AGGREGATE $ 5,000,000
<br /> DED X RETENTION$ 10,000
<br /> $
<br /> D WORKERS COMPENSATION X PER OTH-
<br /> ANDEMPLOYERS'LIABILITY STAT TE ER
<br /> 21412024 1214/2025 E.L.EACH ACCIDENT $
<br /> ANY PROPRIETORIPARTNERIEXECUTIVE N 4087479726 1 1,OO Q,UOO
<br /> OFFICERIMEMBER EXCLUDED? [� N I A
<br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE S 1,000,000
<br /> If yes,describe under
<br /> DESCRIPTION OF OPERATIONS below E.L,DISEASE-POLICYLfMIT S 1,000,000
<br /> E Professional Liab 83 OH 0489503-24 1214/2024 121412025 Ea Claim/Agg 5,000,000
<br /> DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Ramarks Schedule,may be attached if more space is required]
<br /> 30-day Notice of Cancellation applies to the Auto Liability policy,form to follow.
<br /> Re:Consultant Agreement for Municipal Plan Check Services City of Santa Ana,officers,agents,employees,and volunteers are named as additionally
<br /> insured on this policy pursuant to written contract,agreement,or memorandum of understanding.Such insurance as is afforded by this policy shall be
<br /> primary,and any insurance carried by City shall be excess and noncontributory per general liability and automobile liability per attached endorsements. 30
<br /> Day Notice of Cancellation on Professional Liability per attached.
<br /> APPROVED
<br /> CERTIFICATE HOLDER CANCELLATION By Cynthia Mora at 8:50 am, Dec 13, 2024
<br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> City of Santa Ana THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br /> ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> Risk Management Division
<br /> 20 Civic Center Plaza,4th Floor
<br /> Santa Ana,CA 92701 AUTHORIZED REPRESENTATIVE
<br /> A` o,l
<br /> ACORD 25(2016103) ©1988-2015 ACORD CORPORATION. All rights reserved.
<br /> The ACORD name and logo are registered marks of ACORD
<br />
|