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0 DATE (MMiODIYYYY)
<br />ACC)R" CERTIFICATE OF LIABILITY INSURANCE
<br />9/10/2014
<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 enclorsement(s).
<br />PRODUCER
<br />CONTACT
<br />NAME:
<br />Dea4ey, Renton & Associates
<br />HONEO, -6810 ACX
<br />tA N E.t):714-427
<br />P JC. tA No:714-427-6818
<br />P. 0. Box 10550
<br />E-MAIL
<br />Santa Ana CA 92711-0550
<br />ADDREss
<br />INSURER(S) AFFORDING COVERAGE
<br />NAC _#_____
<br />EACH OCCURRENCE
<br />$1,000,000
<br />_rNsuRERA--TrayeLe.rS. operty Casualty CoofA
<br />25674
<br />INSURED
<br />INSURER B:Tr ave1ors[n ndeni—_ nity
<br />_
<br />Coast Surveying, Inc
<br />INSURER C:Travelers Casualty
<br />$1,000,000
<br />15031 Parkway Loop, Suite B
<br />$10,000
<br />Tustin
<br />Tustin CA 92780-6527
<br />INSURER
<br />INSURER E
<br />PERSONAL & ALDV INJURY
<br />I INSURER F
<br />Liability
<br />I
<br />COVERAGES CERTIFICATE NUMBER: 462074368 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 />LTR
<br />PE OF INSURANCE
<br />ADDLSUBR
<br />INSR
<br />VVVD
<br />POLICY NUMBER
<br />POLICY EFF POLICY EXP
<br />(MM Ul"yyyy) MMQDIYYYY)
<br />.. . .......... ....... ..... . .. . .... . ......
<br />LIMITS
<br />B
<br />GENERAL LIABILITY
<br />6804948L280
<br />9/1812014 )/1812015
<br />EACH OCCURRENCE
<br />$1,000,000
<br />X COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE I Fv� I OCCUR
<br />M
<br />DA AGE TO RENTED
<br />PREMISES
<br />$1,000,000
<br />IVIED EXP (Any one person)
<br />$10,000
<br />X Contractu@I
<br />PERSONAL & ALDV INJURY
<br />$1,000,000
<br />Liability
<br />APPROVEID AS TO
<br />FORM
<br />GENERAL AGGREGATE
<br />$2,000,000_____
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />POLICY ITP
<br />J
<br />] Roi LOC F7
<br />E,
<br />PRODUCTS - COMP(OP AGG
<br />$2,000,000
<br />$
<br />I
<br />AUTOMOBILE
<br />LIABILITY�EaMBINE
<br />GO 0!51N(�LL LIMI I
<br />accident�
<br />$
<br />Laura A. Rosom
<br />BODILY INJURY (Per person)
<br />$
<br />ANY AUTO
<br />ALL OWNED SCHEDULEDnt
<br />AUTOS AUTOS
<br />Senior AssistaCity
<br />Attornev
<br />BODILY INJURY (Per accident}
<br />$
<br />PROPERTY DAMAGE
<br />Per accicen
<br />$
<br />HIRED AUTOS NON -OWNED
<br />AUTOS
<br />A
<br />X
<br />UMBRELLA LIAB x
<br />I
<br />OCCUR
<br />CUP4156T601
<br />11812014
<br />)/18/2015
<br />EACH OCCURRENCE
<br />- ... . .................
<br />$5,000,000
<br />RDED
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />AGGREGATE
<br />$5,000,000
<br />. . . . ............ ............ .
<br />RETENTION$
<br />A
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY YIN
<br />ANY PROPRIETORIPARTMERJEXECUTIVE❑
<br />UB7836Y81 4
<br />9/18/2014
<br />D/18/2015
<br />X TWO STATIU �!2-
<br />DRY LIM S
<br />E.L. EACH ACCIDENT
<br />$1,000,000
<br />OFFICERIMEMBER EXCLUDED?
<br />NIA
<br />E.L. DISEASE - EA EMPLOYEE
<br />$1,000,000
<br />(Mandatory in NH)
<br />if as describe under
<br />0 , RI PTION OF OPERATIONS' elow
<br />E.L. DISEASE -POLICY LIMIT
<br />$1,000,000
<br />C
<br />Professional Liability
<br />105343474
<br />9118/2014
<br />/18/2015
<br />Per Claim $1,000,000
<br />l
<br />Claims Made
<br />Annual Aggr. $2,000,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, AddAional Remarks Schedule, if more space is required)
<br />General Liability policy excludes claims arising out of the performance of professional services.
<br />Re: All Operations as pertains to named insured. The City of Santa Ana, its officers, employees, and representatives are Additional Insured
<br />as respects to General Liabiflty coverage as required by written contract. Coverage afforded the Additional Insured is Primary &
<br />Non -Contributory as required by written contract. Waiver of Subrogation included in Work Compensation as required by written contract.
<br />lK111111:41.4 112 Lff-1111=111; Lai 411:1 W-119L":44w-llllLolgi5ifilopwmllmppmkqlolMG-MUlmilm-almagwi-trI-na �
<br />City of Santa Ana
<br />Attn: David Ip,
<br />P.O. Box 1988
<br />Santa Ana CA 92702
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />AUTHORIZED REPRESENTATIVE
<br />@ 1988-2010 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD
<br />
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