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Acoa 1 0 CERTIFICATE OF LIABILITY INSURANCE
<br />��.
<br />DATE 07101(ho`,'4 Y)
<br />)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(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 />Marsh Risk & Insurance Services
<br />17901 Von Karmen Avenue #1100
<br />CONTACT
<br />NAME:
<br />_(HG NN ExO A/c Nn:
<br />(949)399 -5800 License #0437153
<br />Who, CA 92614
<br />E -MAIL
<br />INSURERS) AFFORDING COVERAGE
<br />NAIC#
<br />EPK- 104545
<br />INSURER Forster Specialty Insurance Cc
<br />44520
<br />960627.01- 0.1 -14 -15
<br />_
<br />INSURED
<br />Placeworks
<br />_A:CIUm&
<br />INSURER B: Travelers Proper Casualty Company OfAmerlca
<br />X COMMERCIAL GENERAL LIABILITY
<br />CLAIMS - MADE ❑OCCUR
<br />---- --- - --
<br />INSURER C
<br />Dba; The Planning Center
<br />Design Community & Enviornment
<br />3 MacArthur Place, Suite 1100
<br />INSURER D:
<br />-DAMAGE TO —RENTED
<br />EMISES (Ed acc opened)
<br />$ _ 50,000
<br />MED
<br />Santa Ana, CA 92707
<br />INSURER E:
<br />$ 500,000
<br />INSURER F:
<br />X BI & PD Ded, $5,000
<br />COVERAGES CERTIFICATE NUMBER; LOS- 001600436 -04 REVISION NUMBER:I
<br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
<br />INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />ILTR
<br />TYPE OF INSURANCE
<br />NSN
<br />SUER
<br />POUCYNUMBER
<br />MMILDIMYEFY
<br />MMID�YY
<br />LIMITS
<br />A
<br />GENERAL LIABILITY
<br />X
<br />X
<br />EPK- 104545
<br />07/01/2014
<br />07/0112015
<br />EACH OCCURRENCE
<br />$ 5,000,DD0
<br />X COMMERCIAL GENERAL LIABILITY
<br />CLAIMS - MADE ❑OCCUR
<br />-DAMAGE TO —RENTED
<br />EMISES (Ed acc opened)
<br />$ _ 50,000
<br />MED
<br />$ 5,000
<br />PERSONAL &ADV INJURY
<br />$ 500,000
<br />X BI & PD Ded, $5,000
<br />GENERAL AGGREGATE
<br />$ 5,000,000
<br />DEAL AGGREGATELIMIT
<br />APPLIES PER:
<br />PRODUCTS - COMPIOP AGG
<br />$ 5,000,000
<br />X POLICY
<br />PRO- LOC
<br />Contractors Pollution
<br />$ 5,000,000
<br />B
<br />AUTOMOBILE
<br />LIABILITY
<br />X
<br />X
<br />BA- 7E316167- TCT -14
<br />0710112014
<br />0710V2015
<br />N D INGLE LIMIT
<br />Ea accident
<br />1,000,000
<br />BODILY INJURY (Per person)
<br />$
<br />X
<br />ANY AUTO
<br />ALL OWNED SCHEDULED
<br />AUTOS AUTOS
<br />BODILY INJURY (Per accident)
<br />$
<br />X
<br />HIRED AUTOS X NON -OWNED
<br />AUTOS
<br />PROPERTY e DAMAGE
<br />$
<br />8
<br />UMBRELLA LIAR
<br />OCCUR
<br />EX- 7E376167- TIL -14
<br />07101/2014
<br />0710112015
<br />EACH OCCURRENCE
<br />$ 4,000,000
<br />X
<br />EXCESS LIAR
<br />rd
<br />CLAIMS -MADE
<br />AGGREGATE
<br />$ 4,000,000
<br />DIED RETENTION
<br />_�__
<br />$
<br />B
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY
<br />ANY PROPRIETOWPARTNER/EXECUTIVE
<br />OFFICERIMEMBER EXCLUDED? N
<br />(Mandatory In NH)
<br />NIA
<br />DB- 7637616.7 -14
<br />0710112014
<br />0710112015
<br />X WCBTATU- OTH-
<br />T Y LI T
<br />E.L. EACH ACCIDENT
<br />$ 1,000,000
<br />E.L. DISEASE - EA EMPLOYE
<br />$ 1,00Qo00
<br />If eedascdbeunder
<br />DE SCRIPTION OF OPERATIONS below
<br />E,L. DISEASE - POLICY LIMIT
<br />$ 1,000,000
<br />A
<br />ERors & Omissions- Glalms Made
<br />EPK - 104545
<br />07/0112014
<br />0710la15
<br />Each ClaimlA9gragate 5,000,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD IOL Additional Remarks Schedule, If more space Is required)
<br />Re: Operations performed by the named Insured for the cenlflcato holder
<br />City of Santa Ana, its officers, agents, employoses, and volunteers are Included as additional ins whore required by written contract with respect to General and Auto Liability. This insurance is primary and non-
<br />contributoryoveranyexistinginsuranceandllmiledtoliabilityarisingoutof the operations ordktGAe'dinsuredan where required by written contract with respect to General Liability. Waiver ofsubrogatlon is
<br />applicable where required by writer contract with respect to General and Auto Liabili4vi ,l>�
<br />. e.
<br />CERTIFICATE HOLDER 11 �y�` 'G° CANCELLATION
<br />City of Santa Ana
<br />Attn: Judy
<br />Civic CA M-20
<br />42Qr ,�
<br />4b
<br />y �C
<br />y+a.�
<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 />aCenter
<br />Sa la 92701
<br />AUTHORIZED REPRESENTATIVE
<br />of Marsh Risk & Insurance Services
<br />John Greet
<br />©19882010 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD
<br />
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