|
Client#: 8419
<br />JOHNEKAL11
<br />ACORD,. CERTIFICATE OF LIABILITY INSURANCE
<br />O1/06/2IDDIYYVY)
<br />1 /0 612 014
<br />THIS CERTIFICATE IS ISSUED ASA 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 P RAi BETWEEN THE ISSUING INSURER(S), AUTHORIZED
<br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFE,I�'4.Qr;CR. s ` U
<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 endprsemer t,tA statement on this certificate does not confer rights to the
<br />certificate holder in lieu of such endorsement(s). i.? I '�
<br />PRODUCER IU
<br />Dealey, Renton & Associates
<br />199 S Los Robles #540
<br />Pasadena, CA 91101
<br />Lic#0020739
<br />NAME. CTtarle Swaney
<br />PHONE 626.844-3070
<br />AIC No Ext: AIC No:
<br />E-MAIL mswaney@insdra.com
<br />V
<br />ADDRESS: yINSURER($)
<br />AFFORDING COVERAGE NAIC 11
<br />INSURER A: Travelers Property Casualty Co 25674
<br />INSURED
<br />John Kaliski Architects dba Urban Studio
<br />INSURER B: Hudson Insurance Company 25054
<br />68067081-374
<br />3780 Wilshire Blvd., Suite 300
<br />Los Angeles, CA 90010
<br />213.383.7980 "`� //
<br />�� � /W�
<br />INSURER C:
<br />INSURER D:
<br />INSURER E:
<br />cab
<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 />INSR
<br />MD
<br />POLICY NUMBER
<br />MMIDIDIYYVY
<br />POLICY EXP
<br />LIMITS
<br />A
<br />GENERAL LIABILITY
<br />X
<br />X
<br />68067081-374
<br />12/13/2013
<br />12/13/2014 EACH s2,000,000
<br />X COMMERCIAL GENERAL LIABILITY
<br />��OCTCTURRENCE
<br />PREMISES ERENcT5rence $2000,000
<br />CLAIMS -MADE A OCCUR
<br />MED EXP (Any one person) $10,000
<br />x Contractual Liab
<br />PERSONAL& ADV INJURY $2,006000
<br />GENERAL AGGREGATE $4,000,000
<br />GEN'L AGGREGATE
<br />LIMIT APPLIES PER:
<br />PRODUCTS - COMPIOP AGG $4,000,000
<br />POLICY
<br />X PRO LOC
<br />JECT
<br />$
<br />A
<br />AUTOMOBILE
<br />LIABILITY
<br />x
<br />BA67081_755
<br />12/13/201312113/201
<br />EeaBcIdDrrhSINGLELIMIT $1,009,000
<br />ANYAUTO
<br />BODILY INJURY (Per person) $
<br />ALL OWNED SCHEDULED
<br />BODILY INJURY (Per accident) $
<br />1XX
<br />AUTOS AUTOS
<br />X NON -OWNED
<br />PROPERTY DAMAGEAUTOS
<br />HIRED AUTOS
<br />Paraccldent
<br />No Owned Auto
<br />$
<br />UMBRELLA LAB
<br />OCCUR
<br />EACH OCCURRENCE $
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />AGGREGATE $
<br />DED RETENTION $
<br />$
<br />A
<br />WORKERS COMPENSATION
<br />UB5276Y706
<br />01109/2014
<br />U- ORH-
<br />01/09/201 X
<br />AND EMPLOYERS' LIABILITY
<br />Twocg'
<br />ANY PROPRIETOR/PARTNER/EXECUTIVE
<br />�
<br />E.L. EACH ACCIDENT $11000000
<br />OFFICER/MEMBER EXCLUDED? N
<br />NIA
<br />(Mandatory In NH)
<br />E.L. DISEASE - EA EMPLOYEE $1,000,000
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE -POLICY LIMIT $1,000,000
<br />B
<br />Professional Liab
<br />AEE7242904
<br />12/11/2013
<br />12/11/2014 $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 Bristol 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 Ana*
<br />20 Civic Center Plaza
<br />PO BOX 1988 M-21
<br />Santa Ana, CA 92702
<br />ACORD 25 (2010105) 1 of 2
<br />#S847898/M840784
<br />� .�..� AS 1,() F01Z
<br />191 SHOULD THEEXPIRATIONDATEDATE ABOVE THEREOF, E NOTICE I WILL ES BE CBE CDELVEREDELLED OIN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />L.nur___ iv
<br />a Stitt S4
<br />mm AUTHORIZED REPRESENTATIVE
<br />Assistant City A.tioroey
<br />© 1988.2010 ACORD CORPORATION. All rights reserved.
<br />The ACORD name and logo are registered marks of ACORD
<br />MISS
<br />
|