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ACC)R " CERTIFICATE OF LIABILITY INSURANCE
<br />9/14E(MM/ D/YYYY)
<br />017
<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-NAME:
<br />DRA License 0020739
<br />P. O. Box 10550
<br />CONTACT
<br />PHONE FAX
<br />_(A/c,xQ,�,• !__L= 7-6810 A/c NQ). 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 />INSURERB:XL Specialty Insurance Co. '3788_5
<br />Coast Surveying, Inc
<br />15031 Parkway Loop, Suite B
<br />Tustin CA 92780-6527
<br />INSURERC:
<br />INSURERD:
<br />— -
<br />INSURER E:
<br />X Contractual
<br />INSURER F :
<br />COVERAGES CERTIFICATE Nt1MRFR- 504798464 RFVICIrVJ NI IMRPR•
<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 />AD
<br />INSD
<br />BR
<br />WVD
<br />POLICY NUMBER
<br />POLICY EFF
<br />MM/DD/YYYY
<br />POLICY EXP
<br />MMIDDIYYYY
<br />LIMITS
<br />A
<br />X COMMERCIAL GENERAL LIABILITY
<br />CLAIMS-MADE1:11 OCCUR
<br />Y
<br />Y
<br />6802H636011
<br />9/18/2017
<br />9/18/2018
<br />EACH OCCURRENCE $1,000,000
<br />DA—MAGE To REN EI D —
<br />PREMISES Ea occurrence $1,000,000
<br />_
<br />MED EXP (Any one person) $10,000
<br />X Contractual
<br />I Liability
<br />PERSONAL &ADV INJURY $1,000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />POLICY PE� LOC
<br />GENERAL AGGREGATE $2,000,000
<br />PRODUCTS - COMP/OP AGG $2,000,000
<br />I $
<br />OTHER:
<br />AUTOMOBILE LIABILITY
<br />COMBINED SINGLE LIMIT$
<br />Ea accident
<br />_ _
<br />BODILY INJURY (Per person) $
<br />ANY AUTO
<br />ALL OWNED SCHEDULED
<br />AUTOS AUTOS
<br />HIRED AUTOS NON -OWNED
<br />AUTOS
<br />BODILY INJURY Per accident $
<br />( )
<br />PROPERTY DAMAGE $
<br />Per accident
<br />$
<br />A
<br />X ! UMBRELLA LIAB
<br />X
<br />OCCUR
<br />CUP4156T601
<br />9/18/2017
<br />9/18/2018
<br />EACH OCCURRENCE $5,000,000
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />AGGREGATE $5,000,000
<br />DED', RETENTION $
<br />$
<br />A
<br />WORKERS COMPENSATIONy
<br />AND EMPLOYERS' LIABILITY Y / N
<br />ANY PROPRIETOR/PARTNER/EXECUTIVE
<br />OFFICER/MEMBER EXCLUDED? ❑
<br />N / A
<br />UB5J731678
<br />9/18/2017
<br />9/18/2018
<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 />MIT E.L. DISEASE - POLICY LI$1,000,000
<br />DESCRIPTION OF OPERATIONS below
<br />B
<br />Professional Liability
<br />Claims Made
<br />DPR9917824
<br />9/18/2017
<br />9/18/2018
<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 />Umbrella policy is a follow -form to underlying General Liability/Auto Liability/Employers Liability.
<br />Re: Design Engineering A-2011-099. The City of Santa Ana, its officers, employees, and representatives are Additional Insured as respects
<br />to General Liability coverage as required by written contract. Coverage afforded the Additional Insured is Primary & Non -Contributory as
<br />required by written contract. Waiver of Subrogation included in Work Compensation as required by written contract.
<br />REVIEWED BY: EUNICE HEREDIA (PG I OF )
<br />I. r%I IFI%IM I L nVLUGR %o1AV4L.CLLHI IUI)I OU LJCIY IVUUUC UI 1. CtI R:CIICIIIUII
<br />City of Santa Ana
<br />P.O. Box 1988 M-36
<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 />©1988-2014 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD
<br />
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