|
Ae"Ra® CERTIFICATE OF LIABILITY INSURANCE
<br />F
<br />$/DATE(M / DNYYY)
<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(les) 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 />PHONEFAX
<br />_(AIC, No, FX)• 714-427-6810 c No): 714-427-6818
<br />E-MAIL
<br />Santa Ana CA 92711-0550
<br />INSURERS AFFORDING COVERAGE NAIC #
<br />INSURER A:TravelersProperty Casualty CoofA 25674
<br />6802H636011
<br />INSURED
<br />INSURER B :Travelers Indemnity Co. of Connecti 25682
<br />Coast Surveying, Inc
<br />15031 Parkway Loop, Suite B
<br />Tustin CA 92780-6527
<br />wsURERC:XL Specialty Insurance Co. 37885
<br />INSURER D;
<br />INSURER E:
<br />X Contractual
<br />INSURER F:
<br />COVERAGES CERTIFICATE NUMBER: 276699136 RFVIRION NLIMRFR-
<br />-----.----- ----------
<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 />ILTR
<br />TYPE OF INSURANCE
<br />INSD.
<br />WVD
<br />POLICY NUMBER
<br />POLICY
<br />POLICY EXP
<br />LIMITS
<br />B
<br />X COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE ❑X OCCUR
<br />6802H636011
<br />9/18/2016
<br />9/18/2017
<br />EACH OCCURRENCE $1,000,000
<br />DAMAGE 'O R TEED
<br />PREMISES (Ea occurrence) $1,000,000
<br />_
<br />MED EXP (Any one person) $10,000
<br />X Contractual
<br />Liability
<br />PERSONAL & ADV INJURY $1,000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />POLICY JE 0 LOC
<br />GENERAL AGGREGATE $2,000,000
<br />PRODUCTS - COMP/OP AGG $2,000,000
<br />$
<br />OTHER:
<br />AUTOMOBILE
<br />LIABILITY
<br />COIV
<br />accident $
<br />BODILY INJURY (Per person) $
<br />ANY AUTO
<br />ALL OWNED SC EDULED
<br />AUTOS AU OS
<br />HIRED AUTOS NON -OWNED
<br />AUTOS
<br />BODILY INJURY Per accident $
<br />( )
<br />ROPERTY DAMAGE
<br />Per accident $
<br />A
<br />X
<br />UMBRELLA LIAB
<br />X
<br />I OCCUR
<br />CUP4156T601
<br />9/18/2016
<br />9/18/2017-1
<br />EACH OCCURRENCE $5,000,000
<br />AGGREGATE $5,000,000
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />DED RETENTION$
<br />$
<br />A
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY Y I N
<br />ANY PROPRIETOR/PARTNER/EXECUTIVE❑
<br />OFFICER/MEMBER. EXCLUDED?
<br />NIA
<br />UB7836Y814
<br />9/18/2016
<br />9/18/2017X
<br />STATUTE ETH
<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 />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE - POLICY LIMIT $1,000,000
<br />C
<br />Professional Liability
<br />Claims Made
<br />DPR9808569
<br />9/18/2016
<br />9/18/2017
<br />Per Claim $2,000,000
<br />Annual Aggr. $2,000,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I 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 of Subrogatio Ii PCiudad in Work Compensation as
<br />required by written contract. 1
<br />REVIEWED BY: OMEUNICE HEREDIA (PG I OF
<br />VGt[I Ir iwAi G nULUUM UANL;tLLA I IUN ov vdy Ivvl.d Iv udy wf iwrirav OT t" rem
<br />City of Santa Ana
<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 />a)
<br />o j
<br />cop-
<br />b�3�+ i f
<br />© 1988-2014 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD
<br />
|