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Client#: 25320 <br />KIMLHORN <br />ACORD,. CERTIFICATE OF LIABILITY INSURANCE <br />FDATE(MM/DD/YYYY) <br />4/12/2017 <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 />ACT <br />NAME: Jerry Noyola <br />Greyling Ins. Brokerage/EPIC <br />PHONE <br />(A/C, No, Ext>: 770-552-4225 �n/c, No): 866-550-4082 <br />3780 Mansell Road, Suite 370 <br />E-MAIL <br />ADDRESS: jerry.noyola@greyling.com <br />Alpharetta, GA 30022 <br />INSURER(S) AFFORDING COVERAGE NAIC # <br />INSURER A: National Union Fire Ins. Co. 19445 <br />INSURED <br />INSURER B : Aspen American Insurance Compan 43460 <br />Kimley-Horn and Associates, Inc. <br />INSURER C : New Hampshire Ins. Co. 23841 <br />421 Fayetteville Street, Suite 600 <br />-INSURER D ;Lloyds of London 085202 <br />Raleigh, NC 27601 <br />INSURER E : <br />INSURER F : <br />COVERAGES CERTIFICATE NUMBER: 17-18 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 />INSR <br />LTR <br />TYPE OF INSURANCE <br />AODL <br />INSR <br />SUBR <br />WVD <br />POLICY NUMBER <br />POLICY EFF <br />MMIDD/VYYY <br />POLICY EXP <br />MM/DD/YYYY <br />LIMITS <br />A <br />X-._ COMMERCIAL GENERAL LIABILITY <br />5268169 <br />4/01 /2017 <br />04/01/2018 <br />EACH OCCURRENCE <br />$1 000,000 <br />CLAIMS -MADE I AI OCCUR <br />PREMISES(E.occu RENTED <br />) <br />$500000 <br />MED EXP (Any one person) <br />$25 000 <br />X Contractual Llab. <br />PERSONAL & ADV INJURY <br />$1 ,000,000 <br />GEN'L AGGREGATE LIMIT APPLLIyIEIS PER: <br />PR <br />POLICY i.......^_I JECOT 'J 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 />4/01/2017 <br />04/01/201 <br />EOaccideDS IINGLELIMIT <br />$1,000,000 <br />BODILY INJURY (Per person) <br />$ <br />X ANY AUTO <br />ALL OWNED SCHEDULED <br />AUTOS AUTOS <br />BODILY INJURY (Per accident) <br />$ <br />NON -OWNED <br />X'. HIRED AUTOS %� AUTOS <br />PROPERTY DAMAGE <br />Per accident <br />$ <br />B <br />X'... UMBRELLA LIAB X OCCUR <br />CX005FT17 <br />4/01/2017 <br />04/01/2018 <br />EACH OCCURRENCE <br />$5000000 <br />AGGREGATE <br />$5 000 000 <br />EXCESS LIAB CLAIMS -MADE <br />$ <br />DED X RETENTION$O <br />C <br />A <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY Y / N <br />ANY PROPRIETOR/PARTNER/EXECUTIVE <br />OFFICER/MEMBER EXCLUDED? F <br />(Mandatory in NH) <br />N / A <br />015893685 (AOS) <br />015893686 (CA) <br />4/01 /2017 <br />4/01 /2017 <br />04/01 /201 <br />04/01 /201 <br />X PE OTH- <br />E.L. EACH ACCIDENT <br />$1 00O 000 <br />E.L. DISEASE - EA EMPLOYEE <br />$1 000,000 <br />It yes, describe under <br />DESCRIPTION OF OPERATIONS below <br />E.L. DISEASE - POLICY LIMIT <br />$1,000,000 <br />D <br />Professional Liab <br />P070831700 <br />4/01/2017 <br />04/01/2018 <br />Per Claim $2,000,000 <br />Aggregate $2,000,000 <br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached it more space is required) <br />Re: On -Call Agreements A-2015-171, A-2009-212 & A-2009-212. The City of Santa Ana, its officers, <br />employees, agents & representatives are named as Additional Insureds with respects to General Liability <br />where required by written contract. The above referenced liability policies with the exception of <br />professional liability are primary & non-contributory where required by written contract. Separation of <br />Insureds applies to the General Liability Policy. Umbrella Follows Form with respects to Genera , <br />(See Attached Descriptions) REVIEWED BY L-UI+ 6(F I t[ sFk DJ A (pt, ) ()F�� }^^ 1 <br />M4 lkk9." MWLf■ l I CI <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 />#S768434/M695961 JNOY1 <br />