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CERTIFICATE OF LIABILITY INSURANCE
<br />DATE )
<br />[211 0/2016(MMIDD/YYYY
<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 />Dealey, Renton & Associates
<br />DRA License 0020739
<br />P. O. Box 10550
<br />CONTACT
<br />NAME:
<br />PHONE 714-427-6810 FAx 714-427-6818
<br />E-MAIL
<br />Santa Ana CA 92711-0550
<br />INSURERS AFFORDING COVERAGE NAIC #
<br />INSURER A: Travelers Pro ert Casualty Co of A 25674
<br />68048491-280
<br />INSURED
<br />INSURERB:Travelers Indemnity Co. of Connecti 25682
<br />Coast Surveying, Inc
<br />15031 Parkway Loop, Suite B
<br />Tustin CA 92780-6527
<br />INSURER C:Beazley Insurance Company, Inc. 37540
<br />INSURER D
<br />INSURER E:
<br />X Contractual
<br />INSURER F :
<br />COVERAGES CERTIFICATE NtIMRFR- 1743747711
<br />P1=vlslnti til IneRGa•
<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 />TYPE OF INSURANCE
<br />ADDLSUBR
<br />INSD
<br />WVD
<br />POLICY NUMBER
<br />POLICY EFF
<br />MM/DDIYYW
<br />POLICY EXP
<br />MM/DD/YYYY
<br />LIMITS
<br />B
<br />X COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE ❑X OCCUR
<br />68048491-280
<br />9/18/2015
<br />9/18/2016
<br />EACH OCCURRENCE $1,000,000
<br />DAMAGE TO RENTED
<br />PREMISES Ea occurrence
<br />_$1,000,000
<br />MED EXP (Any one person) $10,000
<br />X Contractual
<br />Liability
<br />PERSONAL 8 ADV INJURY $1,000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />POLICY JEST LOC
<br />GENERAL AGGREGATE $2,000,000
<br />PRODUCTS - COMP/OP AGG $2,000,000
<br />$
<br />OTHER:
<br />AUTOMOBILE
<br />LIABILITY
<br />BINED IN LIMIT
<br />Ea Maccident $
<br />BODILY INJURY (Per person) $
<br />ANY AUTO
<br />AUTOWNEDL SCHEDULED
<br />AUTOS
<br />HIRED AUTOS NON -OWNED
<br />AUTOS
<br />BODILY INJURY (Per accident) $
<br />PROPERTY DAMAGE
<br />Per accident $
<br />A
<br />X
<br />UMBRELLA LIAB
<br />X
<br />OCCUR
<br />CUP4156T601
<br />9/18/2015
<br />9/18/2016
<br />EACH OCCURRENCE $5,000,000
<br />AGGREGATE $5,00__0_,0_00
<br />EXCESS LAB
<br />CLAIMS -MADE
<br />DED I I RETENTION $
<br />$
<br />A
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY Y / N
<br />ANY PROPRIETOR/PARTNER/CU I —
<br />OFFICER/MEMBER EXCLUDED? ❑
<br />N / A
<br />UB7836Y814
<br />9/18/2015
<br />9/18/2016
<br />X PER OTH-
<br />STATUTE ER
<br />E.L. EACH ACCIDENT $1,000,000
<br />E.L. DISEASE- EA EMPLOYE- $1,000,000
<br />(Mandatory in NH)
<br />If yes, describe under
<br />E.L. DISEASE - POLICY LIMIT 1 $1,000,000
<br />DESCRIPTION OF OPERATIONS below
<br />C
<br />Professional Liability
<br />Claims Made
<br />V1963E150101
<br />9/18/2015
<br />9/18/2016
<br />Per Claim $2,000,000
<br />Annual Aggr. $2,000,000
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
<br />General Liability policy excludes claims arising out of the performance of professional services.
<br />Re: Design Engineering A-2011-099, Construction Engineering A-2014-101. The City of Santa Ana, its officers, employees, and
<br />representatives are Additional Insured as respects to General Liability coverage as required by written contract. Coverage afforded the
<br />Additional Insured is Primary & Non -Contributory as required by written contract. Waiver f S brogation included in Work Compensation as
<br />required by written contract. - I�_--
<br />C REVi WED BY: _l i=t M; E iiiLRt.:DIA(Pf fl. .O 4;
<br />t,rm i Int,m i r- nvLucrc I.AIVI,CLLA I IVIN OV vdy IV V1 / I U Ubly IUr Ivunray 01 rrem
<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 ACCORDANCE WITH THE POLICY PROVISIONS.
<br />P.O. Box 1988
<br />Santa Ana CA 92702
<br />AUTHORIZED REPRESENTATIVE
<br />© 1988-2014 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD
<br />THIS CERTIFICATE SUPERSEDES PREVIOUSLY ISSUED CERTIFICATE
<br />
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