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ACCDIR®'
<br />�,. CERTIFICATE OF LIABILITY INSURANCE
<br />DATE (MM/DD/YYYY)
<br />2/3/2017
<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
<br />Dealey, Renton & Associates
<br />DRA License 0020739
<br />P. O. Box 10550
<br />CONTACT
<br />NAME:
<br />PHONEFAX
<br />A/C, Na, Ext)• 714-427-6810 A/C Ne): 714-427-6818
<br />E DRIESS:
<br />INSURERS AFFORDING COVERAGE NAIC #
<br />Santa Ana CA 92711-0550
<br />INSURERA:Travelers Property Casualty Co of 25674
<br />6802H913436
<br />INSURED
<br />INSURERB:Travelers Casualty & Surety Co. Ame 31194
<br />RJM Design Group, Inc.
<br />INSURERC:Travelers Indemnity Co. ofConnecti 25682
<br />31591 Camino Capistrano
<br />San Juan Capistrano CA 92675
<br />INSURER D :_
<br />INSURER E:
<br />INSURER F:
<br />COVERAGES CERTIFICATE NUMBER: 33303936 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 />ILTR
<br />TYPE OF INSURANCE
<br />IAN D
<br />y VD�
<br />POLICY NUMBER
<br />MM DD/YYYY ICY EFF
<br />POLICY EX
<br />LIMITS
<br />A
<br />X COMMERCIAL GENERAL LIABILITY
<br />Y
<br />Y
<br />6802H913436
<br />9/30/2016
<br />9/30/2017
<br />EACH OCCURRENCE
<br />$2,000,000
<br />CLAIMS -MADE ❑X OCCUR
<br />DAMAGE TO RENTED
<br />PREMISES Ea occurrence
<br />$1,000,000
<br />MED EXP (Any one person)
<br />$10,000
<br />X Contractual
<br />Liability
<br />PERSONAL & ADV INJURY
<br />$2,000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />GENERAL AGGREGATE
<br />$4,000,000
<br />POLICY IA PE LOC
<br />PRODUCTS -COMP/OP AGG
<br />$4,_000,000
<br />_
<br />$
<br />OTHER:
<br />C
<br />AUTOMOBILE LIABILITY
<br />Y
<br />BA5D394305
<br />9/30/2016
<br />9/30/2017
<br />BINED SINGLE LIMIT
<br />Ea accident
<br />$1,00_0,000
<br />BODILY INJURY (Per person)
<br />$
<br />ANY AUTO
<br />'.. AUTOWNED SCHEDULED
<br />BODILY INJURY (Per accident)
<br />$
<br />NON -OWNED
<br />X 'HIRED AUTOS X AUTOS
<br />PROPERTY DAMAGE
<br />Per accident
<br />$
<br />$
<br />A
<br />X UMBRELLA LAB
<br />X
<br />OCCUR
<br />CUP6E235883
<br />9/30/2016
<br />9/30/2017
<br />EACH OCCURRENCE
<br />$1,000,000
<br />AGGREGATE
<br />'... EXCESS LAB
<br />CLAIMS -MADE
<br />DED RETENTION $
<br />_$1,000,000
<br />$
<br />A
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY YIN
<br />UB413OT960
<br />9/30/2016
<br />9/30/2017
<br />PER OTH-
<br />X STATUTE ER
<br />E.L. EACH ACCIDENT
<br />—_
<br />$1,000,000
<br />ANY PROPRIETOR/PARTNER/EXECUTIVE
<br />OFFICERIMEMBER EXCLUDED?
<br />N / A
<br />--
<br />E.L. DISEASE - EA EMPLOYEE
<br />.__._
<br />$1,000,000
<br />(Mandatory in NH)
<br />If yes, describe under
<br />-
<br />— --------
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE: POLICY LIMIT
<br />$1,000,000
<br />B
<br />Professional Liability
<br />105991919
<br />10/1/2016
<br />10/1/2017
<br />Per Claim $1,000,000
<br />Claims Made
<br />,
<br />1
<br />1
<br />Annual Aggr. $2,000,000
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
<br />General Liability policy excludes claims arising out of the performance of professional services.
<br />Re: A-2009-023 and A-2014-223-01.
<br />The City of Santa Ana, its officers, employees and representatives are Additional Insured as respects to General and auto Liability coverage
<br />as required by written contract.
<br />Primary and Non -Contributory applies to General Liability as required by written contract. Waive47ofS gation for Work Comp is included as
<br />required by written contract. _. I___^ __.._......_._.. _.......________._._...____..._
<br />See Attached... FtEVkLVVED BY' i t1NICE k IRw..REI..)BA
<br />111191MI:an20Ka��iL•Jtta:I
<br />City of Santa Ana
<br />Attn: Marilyn Boothe
<br />P.O. Box 1988
<br />Santa Ana, CA 92702-1988
<br />CELI_ATION ou uay INuu/ I u uay Tor IvonF-ay OT [-rem
<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 />I
<br />© 1988-2014 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD
<br />
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