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<br />GILL&PA-01 SMITHA
<br />R CERTIFICATEOF LIABILITY INSURANCE
<br />OAT121201W )
<br />8!11212014
<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 holderis 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 lieuof such endorsement(s).
<br />PRODUCER License # OE67768
<br />(OA Insurance Services -SD
<br />4350
<br />4350 La Jolla Village Drive, Suite 900
<br />San Diego, CA 92122
<br />co TA T
<br />NAME:
<br />PHONE
<br />(AIC. No Beau 619 574.6220 Aix Nd : 619 574.6288
<br />AIL
<br />ADDRESS:
<br />INSURER(S) AFFORDING COVERAGE NAIC#
<br />INSURERAALIInsuranceCompany 13056
<br />INSURED
<br />INSURER.e,Attantic Specialty Insurance Com any 27154
<br />INSURER C.:
<br />Gillis & Panichapan Architects, Incorporated
<br />INSURER 0: —._...._.......___-
<br />2900 Bristol St. Suite G205
<br />Costa Mesa, CA 92626
<br />...,_._....._...._
<br />INSURER E
<br />INSURER F
<br />0712,112015
<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 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 />(LTR
<br />TYPE OF INSURANCE
<br />Men
<br />MD
<br />POLICY NUMBER
<br />MMI6UIYYYY
<br />120,' EYY
<br />LIMITS
<br />A
<br />X I COMMERCIAL GENERAL LIABILITY
<br />EACH OCCURRENCE $ 2,000,00
<br />CrlIctu MADE1�1 OCCUR
<br />PS60001 N9
<br />0712412014
<br />0712,112015
<br />_CAMXGA[NTE( PREMISES,(Ea,Qgg,Pr Ace $ 1,000rOO
<br />X Contractual l -lab.
<br />MEDEXP(Anyone�erson) $ 10,000
<br />X Ded.: $0
<br />............._.
<br />PERSONAL &ADV INJURY $ 2,000,00
<br />GEN'L AGGREGATE LIMIT APPLIES PER;
<br />GENERALAGGREOATE $ 4,000,00
<br />POLICY ff] JECT 0 LOU
<br />PRODUCTS - COMP/OP AGO $ 4,000,00
<br />$
<br />OTHER:
<br />AUTOMOBILE
<br />LIABILITY
<br />COMBINED SINGLE LIMIT $ 1,000,00
<br />(Ed accident
<br />A
<br />X
<br />ANYAUTO
<br />PSA0001115
<br />06/01/2014
<br />06/0112015
<br />BODILY INJURY Dear person) $
<br />ALL OWNED SCHEDULED
<br />AUTOS AUTOS
<br />BODILY INJURY Per accident
<br />( ) $
<br />NON -OWNED
<br />AUTOSAUTOS
<br />MAGE
<br />P"2 Y JDA
<br />(PMAZJdenn $
<br />X
<br />Cgmp.51,ao0 X COIL $1,000
<br />$
<br />X
<br />UMBRELLA LIAS
<br />X
<br />OCCUR
<br />EACH OCCURRENCE $ 3,000,00
<br />A
<br />EXCESS LIAR
<br />CLAIMS-MAOE
<br />PSEOOO1038
<br />0712412014
<br />07124/2015
<br />AGGREGATE $ 3,000,00
<br />DEC) I X I RETENTION$ 0
<br />$
<br />WORKERS COMPENSATION
<br />PE OTH-
<br />STATUTE ER
<br />AND EMPLOYERS' LIABILITY Y/�—N
<br />E.L. EACH ACCIDENT $ 1,000,00
<br />A
<br />ANY PROPRIETOR(PARTNER/EXECUTIVE
<br />IPSW0001177
<br />09101/2013
<br />0910112014
<br />OFICERIMEMBER EXCLUDED?
<br />MIA
<br />E.L. DISEASE -EA EMPLOYEE $ 1,000,00
<br />tMandatory in NH)
<br />Ues, describe under
<br />DESCRIPTION OF OPERATIONS Below
<br />EA..DISEASE- POLICY LIMIT $ 1,000,00
<br />B
<br />Prof LlablCims Made
<br />DPL287613
<br />11108/2013
<br />11/08/2014
<br />Per Claim 1,000,00
<br />B
<br />Ded.: $5k Per Claim
<br />OPL287613
<br />11108/2013
<br />11108/2014
<br />Aggregate 2,000,00
<br />DESCRIPTION OF OPERATIONS I LOCATIONS!VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required)
<br />Re: All Operations
<br />The City of Santa Ana is Additional Insured with respect to General Liability per the attached endorsement as required by written contract.
<br />30 Days Notice of Cancellation with 10 Days Notice for Non -Payment of Premium In accordance with the policy provisions.
<br />lY+
<br />o-q?,D P''s
<br />CERTIFICATE HOLDER. CANCELLATION I%L�' t ISA r- ""n♦+nrneV I �
<br />©1988-2014 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD
<br />p�gistea -
<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 />AUTHORIZED REPRESENTATIVE
<br />Clerk of the City Council
<br />20 Civic Center Plaza (M-30)
<br />P.O. Box 1988
<br />Santa Ana A 92702
<br />U
<br />©1988-2014 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD
<br />
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