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A� °® CERTIFICATE OF LIABILITY INSURANCE <br />6/18/2015D) <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 />Dealey, Renton & Associates <br />199 S Los Robles Ave Ste 540 <br />Pasadena, CA 91101 <br />CONTACT Marie Swaney <br />PHONE FAX <br />. 626 844 -3070 (AM Net <br />EMAIL . mswaney @insdra.com <br />INSURERS AFFORDING COVERAGE <br />NAIC# <br />Lic #0020739 <br />INSURERA:Travelers Property Casualty Cc of A <br />25674 <br />12/13/2014 <br />INSURED JOHNEKAL11 <br />INSURER B:Hudson Insurance Company <br />25054 <br />John Kaliski Architects dba John Kaliski Arch. <br />INSURERC:Travelers Indemnity Co. of Connecti <br />25682 <br />3780 Wilshire Blvd., Suite 300 <br />Los Angeles, CA 90010 <br />INSURER D: <br />213 383 -7980 <br />INSURER E: <br />INSURER F: <br />$10,000 <br />COVERAGES CERTIFICATE NUMBER: 1558941055 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 />ILTR <br />TYPE OF INSURANCE <br />INSD <br />MD <br />POLICY NUMBER <br />MM% DYE <br />MMIDDY� <br />LIMITS <br />C <br />GENERAL LIABILITY <br />Y <br />Y <br />6806708L374 <br />12/13/2014 <br />12/13/2015 <br />EACH OCCURRENCE <br />$2,000,000 <br />tXCOMMERCIAL <br />CLAIMS -MADE XI OCCUR <br />DAMAGE TO RENTED PREMISES RENT rrenca <br />$2,000,000 <br />MED EXP (Any one person) <br />$10,000 <br />ntractual Liab <br />1 <br />PERSONAL &ADV INJURY <br />$2,000,000 <br />AGGREGATE LIMIT APPLIES PER: <br />GENERAL AGGREGATE <br />$4,000,000 <br />GENL <br />(ej^' <br />POLICY JEST LOG <br />OTHER: <br />((�� <br />(o <br />PRODUCTS- COMP/OP AGO <br />$4,000,000 <br />$ <br />A <br />AUTOMOBILE <br />LIABILITY <br />ANYAUTO <br />Y <br />Y <br />BA670BL755 p <br />`/ <br />2113/2014 <br />12/13/2015 <br />Ea a aide t ) E LIMIT <br />$1,000,000 <br />BODILY INJURY (Per person) <br />$ <br />ALI OWNED SCHEDULED <br />' <br />BODILY INJURY (Per accident) <br />$ <br />X <br />HIRED AUTOS X NON -OWNED <br />AUTOS <br />PROPERTY DAMAGE <br />Per accident <br />$ <br />$ <br />X <br />NoOwnedAutos <br />UMBRELLA LIAB <br />OCCUR <br />EACH OCCURRENCE <br />$ <br />AGGREGATE <br />$ <br />EXCESS LIAB <br />CLAIMS -MADE <br />DED I I RETENTION$ <br />$ <br />A <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY YIN <br />y <br />UB5276Y706 <br />1/9/2015 <br />1/9/2016 <br />X PER OTH- <br />STATUTE ER <br />ANY PROPRIETORIPARTNERIEXECUTIVE <br />E.L. EACH ACCIDENT <br />$1,000,000 <br />OFFICER/MEMBER EXCLUDED? ❑ <br />NIA <br />E.L. DISEASE - EA EMPLOYE <br />$1,000,000 <br />(Mandatory In NH) <br />If yes, describe under <br />DESCRIPTION OF OPERATIONS below <br />E.I DISEASE - POLICY LIMIT <br />$1,000,000 <br />B <br />Professional Liability <br />AEE7242905 <br />12/1112014 <br />12/11/2015 <br />$1,000,000 Per Claim <br />Claims Made Form <br />$2,000,000 Annl Aggregate <br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORO 101, Additional Remarks Schedule, may be attached if more space is required) <br />General Liability policy excludes claims arising out of the performance of professional services. Insured owns no company vehicles; <br />therefore, hired /non -owned auto is the maximum coverage that applies. <br />Re: On -call services, 0210 141125 -- City of Santa Ana, its officers, employees, agents,volunteers and representatives are named as <br />additional insured as respects general & auto liability for claims arising from the operations of the named insured as required per contract or <br />agreement. NOTE: Insurance includes primary and non - contributory wording and waiver of subrogation per attached policy endorsement, <br />(see section B &C of GL form #CG D3 82 09 07). <br />CERTIFICATE HOLDER CANCELLATION 30 Day NOC /10 Day for Non Pay of Prom <br />@ 1988 -2014 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />City of Santa Ana <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />Attn: Exec. Dir of PBA <br />PO BOX 1988 <br />AUTHORIZED REPRESENTATIVE <br />Santa Ana CA 92702 <br />,, + <br />@ 1988 -2014 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD <br />