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Client#: 25320
<br />IINIIT, 4wW 1.101
<br />ACORD,. CERTIFICATE OF LIABILITY INSURANCE
<br />FDATE(MM/DD/YYYY)
<br />5/10/2016
<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 />NAME: Jerry Noyola
<br />Greyling Ins. Brokerage/EPIC
<br />PHONE FAX
<br />A/c, No, Ext : 770-552-4225 A/C, No): 866-550-4082
<br />3780 Mansell Road, Suite 370
<br />ADDRESS:_ jerry.noyola@greyling.com
<br />Alpharetta, GA 30022
<br />877 908-5619
<br />INSURER(S) AFFORDING COVERAGE NAIC #
<br />INSURER A: National Union Fire Ins. Co. 19445
<br />INSURED
<br />INSURER B : Commerce & Industry Ins. Co. 19410
<br />Kimley-Horn and Associates, Inc.
<br />INSURER C : New Hampshire Ins. Co. 23841
<br />P.O. Box 330
<br />INSURER D : Lloyds of London 085202
<br />Raleigh, INC 27636
<br />INSURERS:
<br />INSURER F :
<br />COVERAGES CERTIFICATE NUMBER: 16-17 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 CONTRACTOR 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 />LTRR
<br />TYPE OF INSURANCE
<br />ADDLISUBRI
<br />WVD
<br />POLICY NUMBER
<br />MM/DD/YYYY
<br />MM/DD/YYYY
<br />LIMITS
<br />A
<br />X COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE U OCCUR
<br />5268169
<br />4/01 /2016
<br />04/01/2017
<br />EACH OCCURRENCE
<br />$1,000,000
<br />PREMISES (ERENTED
<br />occu ence)
<br />s500,000
<br />MED EXP (Any one person)
<br />$25 000
<br />X Contractual Liab.
<br />PERSONAL & ADV INJURY
<br />$1,000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />POLICY ( Al JECOT I —XI LOC
<br />GENERAL AGGREGATE
<br />$2,000,000
<br />PRODUCTS - COMP/OP AGG
<br />$ 2,000,000
<br />$
<br />OTHER:
<br />A
<br />AUTOMOBILE LIABILITY
<br />4489663
<br />4/01 /2016
<br />04/01 /201
<br />COMBINED SINGLE LIMIT
<br />Ea accident
<br />11,000,000
<br />BODILY INJURY (Per person)
<br />$
<br />X ANY AUTO
<br />ALL OWNED SCHEDULED
<br />AUTOS AUTOS
<br />X HIRED AUTOS X NON -OWNED
<br />AUTOS
<br />BODILY INJURY (Per accident)
<br />$
<br />PROPERTY DAMAGE
<br />Per accident
<br />$
<br />B
<br />X. UMBRELLA LIAB X OCCUR
<br />BE013778306
<br />4/01/2016
<br />04/01/2017
<br />EACH OCCURRENCE
<br />s5,000,000
<br />AGGREGATE
<br />$5 000 000
<br />EXCESS LIAB CLAIMS -MADE
<br />$
<br />DED I XRETENTION $1 O 00O
<br />1
<br />1
<br />1
<br />`+
<br />A
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY Y / N
<br />ANY PROPRIETOR/PARTNER(EXECUTIVE
<br />OFFICER/MEMBER EXCLUDED? ®
<br />(Mandatory in NH)
<br />N / A
<br />15893685(AOS)
<br />15893686 (CA)
<br />4/01/2016
<br />4/01 /2016
<br />04/01/2017
<br />04/01/2017
<br />X IPER OTH-
<br />E.L. EACH ACCIDENT
<br />$1,000,000
<br />E.L. DISEASE - EA EMPLOYEE
<br />-
<br />$1,000,000
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE - POLICY LIMIT
<br />$1,000,000
<br />D
<br />Professional Liab
<br />P070831600
<br />4/01/2016
<br />04/01/2017
<br />Per Claim $2,000,000
<br />Aggregte $2,000,000
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
<br />Re: On -Call Agreements A-2015-171 & A-2009-212. The City of Santa Ana, its officers, employees, agents &
<br />representatives are named as Additional Insureds with respects to General Liability where required by
<br />written contract. The above referenced liability policies with the exception of professional liability are
<br />primary Y q Y p p e
<br />General Liability Policy. Umbrella Follows Form with respects to General Automob le & , l I to � Liability
<br />Y Y• p �. .+, ._ to ...—E It : h II:I_:� ( c cn)_.y
<br />(See Attached Descriptions) REVIEWED ava �� /
<br />l.Cr1 I Iril..H I r- MVLUMM
<br />City of Santa Ana SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />Purchasing Department ACCORDANCE WITH THE POLICY PROVISIONS.
<br />20 Civic Center Plaza
<br />Santa Ana, CA 92701-0000 AUTHORIZED REPRESENTATIVE
<br />©1988-2014 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2014/01) 1 of 2 The ACORD name and logo are registered marks of ACORD
<br />#S484397/M461305 JNOY1
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