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ACOCERTIFICATE OF LIABILITY INSURANCE D//2010010) 11/21/21R" THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Ames and Gough 450 Northridge Parkway Suite 102 Atlanta GA 30350 CONTACT Jerry NO Ola NAME: y y acNloExt: (770)552-4225 FAX ADDRIESS:Jnoyola0amesgough.com PRODUCER 00001398 INSURERS AFFORDING COVERAGE NAICB INSURED Kimley-Horn and Associates, Inc. P.O. Box 33068 Raleigh NC 27636 INSURERA:Travelers Indemnity Co. of CT 25682 INSURERB:Travelers Indemnity Company 25658 INSURERC:Travelers Property Casualty Co. 25674 INSURERD:Phoenix Insurance Company 25623 INSURER E :Lexin ton Insurance Company _ 19437 1 INSURERF:Travelers Prop. Cas. Co America 25674 COVERAGES CERTIFICATE NUMBER:*10-11 (Kimley Jessica) REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL SUBR' POLICY NUMBER POLICY EFF MM/DDNYYY POLICY EXP ' LIMITS MM/DDNYYY GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY _ �.. EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES Ea occurrence $ 11000, 000 MED EXP (Any one person) $ 10,000 A f CLAIMS -MADE X OCCUR P-630-8193899A-TCT-10 12/1/2010 12/1/2011 PERSONAL & ADV INJURY _ $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY X PRO X LOC $ B AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS P-810-5724B497-IND-10 12/1/2010 12/1/2011 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 X BODILY INJURY (Per person) $ $ -- BODILY INJURY (Per accident) -X- SCHEDULED AUTOS HIRED AUTOS 'I PROPERTY DAMAGE (Per accident) $ X Underinsured motorist BI split - $ NON -OWNED AUTOS Uninsured motorist property $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000 EXCESS LIAB CLAIMS -MADE AGGREGATE . $ 5, OOO, 000 DEDUCTIBLE $ C ' X iRETENTION $ 10,000 PSM-CUP-8193B99A-TIL-10 12/1/2010 12/1/2011 $ D F WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? N (Mandatory in NH) I7 yes, describe under DESCRIPTION OF OPERATIONS below PNUB-8193B99A-10 N/A'I PNUB-8193B99A-10 (CA) 12/1/2010 12/1/2010 12/1720 11 12/1/2011 WCSTATUTH- X T RY LIMIT- OER E.L. EACH ACCIDENT ......... $ 500, 000 — E.L. DISEASE - EA EMPLOYE r---- E.L. DISEASE - POLICY LIMIT - $ 500 000 -------- $ 500,000 E Professional Liability 016017332 12/9/2010 12/1/2011 Per Claim $2, 000, 000 Aggregate $2, 000, 000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Re: McFadden McDonalds. The City of Santa Ana, its officers, employees & volunteers are named as Additional Insureds on the above referenced liability policies with the exception of workers compensation & professional liability. Umbrella Follows Form. 114.211 a 07-1111q City of Santa Ana Planning Division P.O. Box 1988 M-20 Santa Ana, CA 92702 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE tias Ormaza/NOYOLA ACUKU 25 (2009/09) INS025 (200909) © 1988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD