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CERTIFICATE OF LIABILITY INSURANCE <br />1i/10/20M3. <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 T`1/ Y AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES <br />BELOW_ THIS CERTIFICATE OF INSURANCE D CgrfSTIMTE,A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED <br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE H LDE I <br />IMPORTANT: If the certificate holder Is an AD L-iNS U.RED, the policy(Ies) must be endorsed. If SUBROGATION IS WAIVED, subject to <br />the terms and conditions of the policy, certain pce?I*& niey require angncjprasment. A statement on this certificate does not confer rights to the <br />certificate holder in lieu of such endorsements ---• ,.. -.'. ";-. �zf <br />PRODUCER '- - <br />Grayling Insurance Brokerage `���D_Da j <br />450 Northridge Parkway. A _1UU <br />Sultta 102 /-� v` <br />Atlanta GA 30350 <br />Jerry Noyola <br />PHONE (770)552-9225 FAX.(966)550-SOB] <br />jarry. noyola®greyl Ing. Com <br />INSURERS AFFORDING COVERAGE MAIC <br />INSURER A:TraVelers Pro Cas. Co America 25674 <br />INSURED <br />Kimley-Horn and Associates, Inc. <br />-P.O. Box 33068INS <br />Ra1ei h NC 27636 <br />INSURER B:TraVelere Indemrait Company 25682 <br />INSURER C:Lexin ton Insurance Cc,rqiDarxy19937 <br />VRER D: <br />INS VRER E : <br />INSURER F: <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 />TYPE OF INSURANCE <br />D <br />POLICY NUMBER <br />POLICY EFF <br />MOLICY EXP <br />LIMITS <br />GENERAL LIABILITY <br />Matias Ormaza/JERRY <br />EACH OCCURRENCE $ <br />PREMISES S 3-000,000 <br />FTR <br />X COMMERCIAL GENERAL LIABILITY <br />CLAIMSMADE OCCUR <br />-630-8193B9 �,-D <br />�✓.�./a011- <br />1' V <br />��-/2012 <br />MED EXP An ma rson $ 10,000 <br />PERSONAL 8 AOV INJURY S 11 000 , 000 <br />GENERAL AGGREGATE $ 2,000,000 <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />POLICY X PRo- X LOC <br />PRODUCTS-COMP/OP AGG $ 1,000,000 <br />1 <br />i <br />1 <br />' I <br />S <br />B <br />AUTOMOBILE LIABILITY <br />X ANY AUTO <br />ALL OWNED SCHEDULED <br />AUTOS AUTOS <br />X HIRED AUTOS X NON -OWNED <br />9 city <br />-810-5724B49 T11-11 <br />Attorney <br />2/1/2011 <br />2/1/2012 <br />E B I •% L IMI 1-000,000 <br />BODILY INJURY (Per person) S <br />BODILY INJURY (Per accftlen) 5 <br />PROPERTYsccd� DAMAGE $ <br />rperUnderinsured <br />—t-ist Bi—IR <br />lit S <br />X UMBRELLA LIAB <br />X OCCUR <br />EACH OCCURRENCE 5 5,000,000 <br />AGGREGATE 5 S, OOO, OOO <br />A <br />EXCESS LIAR <br />CLAIMS -MADE <br />DEO I X I RETENTIONS 10,00 <br />S <br />SM-CVP-8193B99A-TZL-11 <br />2/1/2011 <br />2/1/2012 <br />A <br />WORKERS COMPENSATION <br />X I WC STATIU OTH- <br />AND EMPLOYERS' LIABILITY <br />ANY PROP RIETOR/PARTNER/EXECUTIVE � <br />OFF ERIMEMBER EXCLUDED? <br />(Mandatory IR NH) <br />MIA <br />a -UB -8193B99 -A-11 <br />2/1/2011 <br />2/1/2012 <br />E -L- EACH ACCIDENT 5 500 000 <br />E.L. DISEASE - EA EMPLOYEd $ 500,000 <br />E -L. DISEASE- POLICY LIMIT S 500,000 <br />IIes. deacrib under <br />DESCRIPTION OF OPERATIONS tl l— <br />C <br />Professional Liability <br />016017332 <br />2/1/2011 <br />2/1/2012 <br />Per Cram $2,000,000 <br />ABBregate $2, 000, 000 <br />DESCRIPTION OF OPERATIONS/ LOCATIONS/ VEHICLES (Attach ACORD 1011, Addill—1 R—A. Sehadvla, If merY epaeo la required) <br />Re: On Call Environmental Services; Seriert- Ciandalla. The City of Santa Ana, its officers, employees & <br />volunteers are named as Additional Insureds on the above referenced liability POlicies with tha exception <br />of workers compensation & professional liability. This inaurance is primary & non-contributory where <br />required by written cont -.Ct. Umbrella Followe Form with respects to General Liability, Automobile <br />Liability & Workers Compensation.. <br />fiLiV1"{V Zo LCU a V/VOJ � l Goo-av 1w Baa., v— --- l 1-1. ru • ryroa • aaa, vee,. <br />INS026 (2010051.01 The ACORD name and logo are registered marks of ACORD <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 />City of Santa Ana <br />Planning Division <br />AUTHORIZED REPRESENTATIVE <br />P.O. BOX 1988 <br />M-20 <br />Santa Ana, CA 92702 <br />Matias Ormaza/JERRY <br />fiLiV1"{V Zo LCU a V/VOJ � l Goo-av 1w Baa., v— --- l 1-1. ru • ryroa • aaa, vee,. <br />INS026 (2010051.01 The ACORD name and logo are registered marks of ACORD <br />