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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 />
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