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Client#: 8419
<br />JOHNEKAL11
<br />ACORDTM CERTIFICATE OF LIABILITY INSURANCE
<br />OATDIYYYY)
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
<br />9/116/206/2013
<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 />CONTACT Marie Swaney
<br />Dealey, Renton & Associates
<br />PHONE FAX
<br />199 S Los Robles #540 q / y
<br />/l� ^r'Q//—
<br />Ezt: AIC No:
<br />E AIL
<br />ADDRESS: mswaney@insdra.Com
<br />Pasadena, CA 91101 �I/� LV U��^o�
<br />EACCryIIHHOCCURRENCE $2,000,000
<br />P06G[sT0(eFNcurrance $2,000,000
<br />INSURERIS) AFFORDING COVERAGE HAIL
<br />626.844.3070
<br />INSURER A: Travelers Property Casualty Co 25674
<br />INSURED
<br />INSURER B: Hudson Insurance Company 25054
<br />John E. Kaliski dba John Kaliski Arch.
<br />3780 Wilshire Blvd., Suite 300
<br />INSURER C:
<br />Los Angeles, CA 90010
<br />INSURER D:
<br />213.383.7980
<br />INSURE
<br />ER
<br />PERSONAL& ADV INJURY $2,000,000
<br />INSURER F
<br />COVERAGES CERTIFICATE NUMBER: 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 />ADDLSUBR
<br />INSR
<br />VWD
<br />POLICYNUMBER
<br />POLICY EFF
<br />MMIDD/YYYY
<br />POLICY EXP
<br />MMIDDIYYYY
<br />LIMITS
<br />A
<br />GENERAL LIABILITY
<br />X
<br />X
<br />68067081_374
<br />12/13/2012
<br />12/13/2013
<br />EACCryIIHHOCCURRENCE $2,000,000
<br />P06G[sT0(eFNcurrance $2,000,000
<br />X COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE a OCCUR
<br />MED EXP (Any one person) $10,000
<br />PERSONAL& ADV INJURY $2,000,000
<br />x Contractual Liab
<br />GENERAL AGGREGATE $4,000,000
<br />GEN'LAGGREGATE LIMIT APPLIES PER:
<br />PRODUCTS COMP/OP AGG $4,000,000
<br />POLICY X PRO LOC
<br />ECT
<br />$
<br />A
<br />AUTOMOBILE
<br />LIABILITY
<br />X
<br />BA67081_75 ROVED
<br />8
<br />1312013
<br />COMBINED SINGLE LIMIT 1,000,000
<br />Ea accident
<br />BODILY INJURY (Per person) $
<br />ANY AUTO
<br />ALL OWNED SCHEDULED
<br />AUTOS AUTOS
<br />BODILY INJURY (par accident) $
<br />Pe a cid o DAMAGE
<br />$
<br />X
<br />X
<br />HIRED AUTOS X AUOTOSWNED
<br />No Owned Auto
<br />UMBRELLA LIAB OCCUR
<br />`
<br />pi/
<br />®•
<br />��
<br />p ��
<br />-3
<br />ty Attorne
<br />On
<br />^�
<br />$
<br />EACH OCCURRENCE $
<br />AGGREGATE $
<br />EXCESS LIAB CLAIMS -MADE
<br />DED RETENTION$
<br />$
<br />_
<br />A
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY
<br />ANY PROPRIETOR/PARTNER/EXECUTIVEYIN
<br />OFFICER/MEMBER EXCLUDED?
<br />NIA
<br />X
<br />UB5276Y706
<br />01/09/2013
<br />01/0912014
<br />X Wo yLITN TV -
<br />E, L. EACH ACCIDENT $1000000
<br />E. L. DISEASE - EA EMPLOYEE $1,000,000
<br />(Mandatory In NH)
<br />If yes, describe Under
<br />DESCRIPTION OF OPERATIONS below
<br />I
<br />E.L. DISEASE -POLICY LIMIT $1,000,000
<br />B
<br />Professional Liab
<br />AEE7242903
<br />12/11/2012
<br />1211112013
<br />$1,000,000 per claim
<br />Claims Made Form
<br />$2,000,000 annl aggr.
<br />DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required)
<br />Cancellation Notice: 30 Day/10 Day for non -pay of premium. General Liability policy excludes claims arising
<br />out of the performance of professional services. Insured owns no company vehicles; therefore hired/non
<br />owned auto is the maximum coverage that applies.
<br />City of Santa Ana, 20 Civic Center Plaza, Santa Ana, California 92701, its officers, employees, agents,
<br />(See Attached Descriptions)
<br />City of Santa Ana
<br />20 Civic Center
<br />Santa Ana, CA 92701
<br />ACORD 25 (2010/05) 1 of 2
<br />#S738955/M641489
<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 />The ACORD name and logo are registered marks of ACORD
<br />SSP
<br />
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