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A� V CERTIFICATE OF LIABILITY INSURANCE <br />DATE (MMlDDlYYYY) <br />11/21/2010 <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 endorsements . <br />PRODUCER <br />Ames and Gough <br />450 Northridge Parkway <br />Suite 102 <br />Atlanta GA 30350 <br />CONTACT Jerry No ola <br />NAME: y y <br />a/c°No EXc: (770) 552-4225 FAX No: <br />ADDRESS:Jnoyola@amesgough.com <br />PRODUCER CUST4ERIDg00001398 <br />INSURER(S) AFFORDING COVERAGE <br />NAICM <br />_ <br />INSURED <br />Kimley-Horn and Associates, Inc. <br />P.O. Box 33068 <br />Raleigh NC 27636 <br />INSURERA:Travelers Indeninity Co. of CT <br />25682 <br />INSURERB:Travelers Indentnity Comnpany <br />25658 <br />INSURERC:Travelers Property Casualty Co. <br />25674 <br />INSURERD:Phoenix Insurance Company <br />25623 <br />INSURER E :Lexin ton Insurance Company <br />19437 <br />INSURER F: Travelers Prop. Cas. Co America <br />25674 <br />COVERAGES CERTIFICATE NUMBER:*10-11 (Kimley Jessica) 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 />' <br />SUBR <br />POLICY EFF <br />POLICY EXP <br />LTR <br />I TYPE OF INSURANCE <br />ba <br />POLICY NUMBER <br />MWDDNYYY <br />MM/DDNYYY <br />LIMITS <br />GENERAL LIABILITY <br />EACH OCCURRENCE $ 1,000,000 <br />X COMMERCIAL GENERAL LIABILITY <br />DAMAGE TO RENTED 1, 000, 000 <br />PREMISES Ea occurrence $ <br />A <br />CLAIMS -MADE l l OCCUR <br />P-630-8193B99A-TCT-10 <br />12/1/2010 <br />12/1/2011 MED�yone person) $ 10,000 <br />_PERSONAL & ADV INJURY $ 1,000,000 <br />GENERAL AGGREGATE_ $ 2,000,000 <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />PRODUCTS - COMP/OP AGG $ 1,000,000 <br />POLICY X PRO-JECT X LOG <br />$ <br />AUTOMOBILE <br />LIABILITY'. <br />COMBINED SINGLE LIMIT <br />$ 1,000,000 <br />(Ea accident) . <br />BODILY INJURY (Per person) <br />$ <br />B <br />ANY AUTO <br />ALL OWNED AUTOS <br />P-810-57248497-IND-10 12/1/2010 <br />12/1/2011 <br />BODILY INJURY (Per accident) <br />$ <br />SCHEDULED AUTOS <br />PROPERTY DAMAGE <br />-- <br />-X <br />HIRED AUTOS <br />(Per accident) <br />$ <br />X <br />Underinsured motorist BI split <br />$ <br />NON -OWNED AUTOS <br />!'! <br />Uninsured motorist property <br />$ <br />X <br />UMBRELLA LIAB <br />X <br />OCCUR <br />EACH OCCURRENCE <br />$ 5,000,000 <br />AGGREGATE <br />$ _5,._000,000 <br />�- <br />EXCESS LIAB 1 <br />CLAIMS -MADE <br />-_— <br />rLIDEDUCTIBLE <br />� $ <br />! <br />I. <br />C <br />X RETENTION $ 10,000 <br />PSM-CUP-8193B99A-TIL-10 12/1/2010 <br />12/1/2011 <br />$ <br />D <br />WORKERS COMPENSATION <br />PNUB-8193B99A-10 12/1/2010 <br />'�12/1/2011 <br />X WCSTATU- OTH- <br />T RY LIMIT ER <br />AND EMPLOYERS' LIABILITY Y / N <br />E.L. EACH ACCIDENT <br />$ 500,000 <br />ANY PROPRIETOR/PARTNER/EXECUTIVE <br />OFFICER/MEMBER EXCLUDED? <br />N/A <br />PNUB-8193B99A-10 <br />E.L. DISEASE - EA EMPLOYEE <br />$ 500,000 <br />(Mandatory in NH) <br />(CA) 12/1/2010 <br />'12/1/20111:' <br />If yes, describe under <br />I.. <br />DESCRIPTION OF OPERATIONS below <br />! <br />E.L. DISEASE- POLICY LIMIT <br />$ 500,000 <br />E <br />Professional Liability <br />016017332 <br />12/9/2010 <br />12/1/2011 <br />Per Claim $2,000,000 <br />Aggregate $2, 000,000 <br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) <br />Re: Project - Consulting Contract City of Santa Ana. The City of Santa Ana, its officers, employees & volunteers are <br />named as Additional Insureds on the above referenced liability policies with the exception of workers compensation & <br />professional liability. Umbrella Follows Form. <br />CERTIFICATE HOLDER C_ANC_FI I ATI(1N <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />City of Santa Ana <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />Planning Division <br />AUTHORIZED REPRESENTATIVE <br />P.O. BOX 1988 <br />M-20 <br />Santa Ana, CA 92702 <br />Matias Ormaza/NOYOLA <br />ACORD 25 (2009/09) 01988-2009 ACORD CORPORATION. All rights reserved. <br />INS025 (200909) The ACORD name and logo are registered marks of ACORD <br />