|
Client#: 8419
<br />JOHNEKALI1
<br />ACORD,. CERTIFICATE OF LIABILITY INSURANCE
<br />DATE5120YYYY)
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
<br />1 12/005/2013
<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 />PH(ArIONE 626.844.3070 FAX
<br />Ezt: AIC No;
<br />199 S Los Robles #540
<br />EMAILo,
<br />ADDRESS; mswaney@insdra.com
<br />Pasadena, CA 91101
<br />1211312014
<br />Lic#0020739
<br />INSURERS) AFFORDING COVERAGE NAIC #
<br />INSURER A: Travelers Property Casualty Cc 25674
<br />INSURED
<br />INSURER B: Hudson Insurance Company 25054
<br />John Kaliski Architects dba Urban Studio
<br />3780 Wilshire Blvd., Suite 300
<br />INSURER C:
<br />PERSONAL &ADV INJURY $2,000,000
<br />Los Angeles, CA 90010
<br />INSURER D:
<br />213.383.7980
<br />INSURER E;
<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 />LTR
<br />TYPE OF INSURANCE
<br />ADDLSUBR
<br />NSR
<br />WVD
<br />POLICY NUMBER
<br />POLICY EFF
<br />POLICY EXP
<br />LIMITS
<br />A
<br />GENERAL LIABILITY
<br />X
<br />X
<br />68067081-374
<br />12/13/2013
<br />1211312014
<br />EACH OCCURRENCE $2000,000
<br />X COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE E� OCCUR
<br />D GE IC&E P /SES eoccurrence $2,600000
<br />MED EXP (Any one person) $10,000
<br />PERSONAL &ADV INJURY $2,000,000
<br />GENERAL AGGREGATE $4,000,000
<br />GEN'LAGGREGATE
<br />LIMIT APPLIES PER',
<br />PRODUCTS - COMRADE AGG $4,000,000
<br />POLICY X
<br />PRO LOC
<br />ECT
<br />$
<br />A
<br />AUTOMOBILE
<br />LIABILITY
<br />x
<br />BA67081_755
<br />12/13/2013
<br />1211312014
<br />COMBINED SINGLE LIMIT Ee accid1,000,660
<br />ent $
<br />BODILY INJURY Ferpemon) $
<br />ANYAUTO
<br />ALL OWNED SCHEDULED
<br />AUTOS AUTOS
<br />BODILY INJURY (Par accident) $
<br />PROPERTY DAMAGE $
<br />Per accident
<br />X
<br />X
<br />HIRED AUTOS X NON -OWNED
<br />AUTOS
<br />No Owned Auto
<br />r� AS
<br />APP APPROVED
<br />P9 %L. A Y
<br />FO FO
<br />Afl
<br />1tlA
<br />$
<br />UMBRELLA UAB
<br />EXCESS LIAB
<br />OCCUR
<br />CLAIMS-MADE}
<br />//S
<br />EACH OCCURRENCE $
<br />AGGREGATE $
<br />DED RETENTION$
<br />$
<br />A
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY YIN
<br />ANY PROPRIETOR✓PARTNERIEXECUTIVE❑
<br />OFFICERIMEMBER EXCLUDED? N
<br />NIA
<br />UB5276Y7((�1P, -
<br />E;SlStaIlt City .
<br />01 ((r1a�jj/22913
<br />Tl�TTl(;}ED
<br />01/09/201
<br />X WCSTATI-I OTH-
<br />E.L. EACH ACCIDENT $1,000000
<br />E.L. DISEASE - EA EMPLOYEE $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 />B
<br />ProfessionalLiab
<br />AEE7242904
<br />12/11/2013
<br />12/11/201
<br />$1,000,000 per claim
<br />Claims Made Form
<br />$2,000,000 annl aggr.
<br />DESCRIPTION OF OPERATIONS I 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 will be mailed to the certificate holder. General
<br />Liability policy excludes claims arising out of the performance of professional services. Insured owns no
<br />company vehicles; therefore, hired/non-owned auto is the maximum coverage that applies
<br />Re: Pre -Design AS for Bistro St Prop, Washington Ave & 17th St, Santa Ana, CA -- City of Santa Ana, its
<br />officers, employees, agents,volunteers and representatives are named as additional insured as respects
<br />(See Attached Descriptions)
<br />City of Santa Al
<br />20 Civic Center Plaza
<br />PO BOX 1988 M-21
<br />Santa Ana, CA 92702
<br />ACORD 25 (2010105) 1 of 2
<br />#S817635/M817633
<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 />MISS
<br />
|