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ACC? " CERTIFICATE OF LIABILITY INSURANCE <br />DATE (MM/DDNYYY) <br />11/2 1/2 010 <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 />Ames and Gough <br />450 Northridge Parkway <br />Suite 102 <br />Atlanta GA 30350 <br />CONTACT JerryNO Old <br />NAME:HOE y <br />EXt: (770) 552-4225 FAX <br />A/CNNo, No: <br />ADDRESS:jnoyola@amesgough.com <br />PRODUCERCUSTOMER ID 00001398 <br />INSURER(S) AFFORDING COVERAGE <br />NAICfi <br />INSURED <br />Kimley-Horn and Associates, Inc. <br />P.O. Box 33068 <br />Raleigh NC 27636 <br />INSURERA:Travelers Indemnity Co. of CT <br />25682 <br />INSURERB:Travelers Indemnity Company <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 />INSURERF:Travelers Pro . 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 />INSRADDL <br />LTR <br />TYPE OF INSURANCE <br />INSR <br />SUBR <br />POLICY NUMBER <br />MM DD/YYYY <br />MM/DDNYYY <br />LIMITS <br />GENERAL LIABILITY <br />EACH OCCURRENCE <br />$ 11000,000 <br />X COMMERCIAL GENERAL LIABILITY <br />DAMAGE TO RENTED <br />PREMISES Ea occurrence <br />$ 1, OOO, OOO <br />A <br />_ _ CLAIMS -MADE OCCUR <br />�iP-630-8193899A-TCT-10 <br />12/1/2010 <br />''; 12/1/2011i <br />MED EXP (Any one person) <br />$ 10,000 <br />PERSONAL & ADV INJURY <br />$ 1,000,000 <br />GENERAL AGGREGATE <br />$ 2,000,000 <br />PRODUCTS - COMP/OP AGG <br />$ 1,000,000 <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />$ -- -- <br />POLICY X PRO- X LOC <br />B <br />AUTOMOBILE LIABILITY <br />ANY AUTO <br />Al <br />ALL OWNED AUTOS <br />P-810-5724B 7 I -10 <br />R Li` <br />12/1/2010 i12/1/2011 <br />TO F'OR <br />COMBINED SINGLE LIMIT <br />(Ea accident) <br />$ 1,000,000 <br />BODILY INJURY (Per person) <br />$ <br />----- <br />BODILY INJURY (Per accident) <br />----..--- <br />$ <br />SCHEDULED AUTOS <br />X -. <br />HIRED AUTOS <br />PROPERTY DAMAGE <br />(Per accident) <br />$ <br />Underinsured motorist BI split <br />$ <br />X NON -OWNED AUTOS <br />, <br />dl I [ I o <br />Uninsured motorist property <br />$ <br />X UMBRELLA LIAB X <br />OCCUR <br />Ali <br />EACH OCCURRENCE <br />$ 51000,000 <br />EXCESS LIAR <br />lll_ <br />CLAIMS -MADE <br />taid <br />Amy <br />AGGREGATE <br />$ 5,000,000 <br />DEDUCTIBLE <br />_ <br />C <br />X RETENTION $ 10,000 <br />PSM-CUP-8193B9-TIL-10 <br />3.2/1/2010 12/1/2011 <br />$ <br />D WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY Y / N <br />ANY PROPRIETOR/PARTNER/EXECUTIVE <br />OFFICER/MEMBER EXCLUDED? � <br />F I,(Mandatory inNH) <br />N / A <br />PNUB-8193B99A-10 <br />PNUB-8193B99A-10 (CA) <br />12/1/2010 <br />12/1/2010 <br />12/1/2011 <br />12/1/2011 <br />X' WCSTATU- OTH- <br />TORY LIMIT ER <br />E.L. EACH ACCIDENT <br />$ 5OO OOO <br />E.L. DISEASE - EA EMPLOYEE <br />------- <br />$ 500,000 <br />Ii yes, describe under <br />DESCRIPTION OF OPERATIONS below <br />E.L. DISEASE- POLICY LIMIT <br />$ 500,000 <br />E Professional Liability <br />016017332 <br />12/9/2010 <br />12/1/2011 <br />Per Claim $2, 000, 000 <br />Aggregate $ 2, 0 0 0, 0 0 0 <br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) <br />Re: On Call Environmental Services; Seriene Ciandella. The City of Santa Ana, its officers, employees & volunteers <br />are 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 CANCFLLATInN <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) © 1988-2009 ACORD CORPORATION. All rights reserved. <br />INS025 (200909) The ACORD name and logo are registered marks of ACORD <br />