|
Client #: 8419
<br />JOHNEKALI1
<br />ACORD,. CERTIFICATE OF LIABILITY INSURANCE
<br />DATE(MM)DDNYYY)
<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 />3/10/2014
<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(ies) 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 />NAME: Of1TACT Marie Swaney
<br />Dealey, Renton &Associates
<br />"r o 626.844 -3070
<br />199 S Los Robles #540
<br />aOO Eel): AC No:
<br />E -MAIL
<br />ADDRESS: mswaney @insdra.com
<br />Pasadena, CA 91101
<br />s2,000,000
<br />Llc #0020739
<br />INSURER(S) AFFORDING COVERAGE
<br />NAIC#
<br />INSURER A: Travelers Property Casualty Co
<br />25674
<br />INSURED
<br />John E Kaliski dba John Kaliskf Arch...
<br />INSURER B: Hudson Insurance Company
<br />25054
<br />INSURER C:
<br />AL& ADV INJURY
<br />3780 Wilshire Blvd., Suite 300
<br />x Contractual Liab
<br />Los Angeles, CA 90010
<br />INSURER D:
<br />213 - 383 -7980
<br />INSURER E:
<br />L AGGREGATE
<br />INSURER F.
<br />UUVercAutb 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 />R
<br />LTR
<br />LT
<br />TYPE OF INSURANCE
<br />ADDLSUBR
<br />INSR
<br />MD
<br />POLICY NUMBER
<br />POLICY EFF
<br />MMIDDNYYY
<br />POLICY E %P
<br />MMIDDrYYYY
<br />LIMITS
<br />A
<br />GENERAL LIABILITY
<br />X
<br />X
<br />68067081-374
<br />12/13/2013
<br />12/13/2014
<br />OCCURRENCE
<br />s2,000,000
<br />X COMMERCIAL GENERAL LIABILITY
<br />CLAIMS-MADE E� OCCUR
<br />EEpAAqCCry�1HH q
<br />PREMI9E5 Eaoccurrance
<br />$2000,000
<br />MED EXPAny one person)
<br />$10000
<br />AL& ADV INJURY
<br />$2,000000
<br />x Contractual Liab
<br />L AGGREGATE
<br />$4,000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER
<br />TS- COMPIOP AGG
<br />$4,000,000
<br />POLICY X PEST LOC
<br />$
<br />A
<br />AUTOMOBILE
<br />LIABILITY
<br />x
<br />BA6708L755
<br />12/13/2013
<br />12/13/201
<br />DSI NGLE LIMIT
<br />ent
<br />MId
<br />1,000,000
<br />NJURY (Per person)
<br />$
<br />ANY AUTO
<br />ALL OWNED SCHEDULED
<br />AUTOS AUTOS
<br />mfg t�
<br />AV r®
<br />•,
<br />'•`NJURY(Peraccldent)
<br />$
<br />X
<br />HIRED AUTOS X AUTOS ED
<br />AUTOS
<br />TY DAMAGE
<br />ent
<br />$
<br />$
<br />X
<br />o Owned Auto
<br />UMBRELLA ILIAD
<br />'OCCUR
<br />JUB5276Y706
<br />'s
<br />O�U
<br />i
<br />EACH OCCURRENCE
<br />$
<br />EXCESS LIAB
<br />CLAIMS - MADE
<br />OMr
<br />A o�
<br />JODG
<br />AGGREGATE
<br />$
<br />DED RETENTION$
<br />$
<br />!_a
<br />$$rplA C6
<br />Alltorn@
<br />A
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY YIN
<br />ANY PROPRIETORJPARTNERIEXECUTIVE
<br />OFFICERIMEMBER EXCLUDED?
<br />NIA
<br />x
<br />01/09/2014
<br />01/09/201
<br />X WC STATU- OTH-
<br />LHT ER
<br />E.L. EACH ACCIDENT
<br />$1,000,000
<br />E,L. DISEASE -EA EMPLOYEE
<br />$1,000,000
<br />(Mandatory in NH)
<br />If yes, describe under
<br />E.L. DISEASE - POLICY LIMIT
<br />$1,000,000
<br />DESCRIPTION OF OPERATIONS below
<br />B
<br />Professional Liab
<br />AEE7242904
<br />12/11/2013
<br />12/11/2014
<br />$1,000,000 per claim
<br />Claims Made Form
<br />$2,000,000 annl aggr.
<br />DESCRIPTION OF OPERATIONS I LOCATIONS /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: On -call services for Urban Design & Architectural Consulting -- The City of Santa Ana, its officers,
<br />employees, agents, volunteers and representatives are named as additional insureds as respects general &
<br />(See Attached Descriptions)
<br />City of Santa Ana* SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />c/o Clerk of the Council ACCORDANCE WITH THE POLICY PROVISIONS.
<br />20 Civic Center Plaza
<br />PO BOX 1988 AUTHORIZED REPRESENTATIVE
<br />Santa Ana, CA 92702 -1988 a , - ,
<br />U 1988.2010 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2010105) 1 of 2 The ACORD name and logo are registered marks of ACORD
<br />#S9111791M840751 MGS
<br />
|