|
Client#: 835015
<br />ALTAPLAN
<br />ACORD,. CERTIFICATE OF LIABILITY INSURANCE
<br />=DJYYYY)
<br />15
<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 />.... . .. .
<br />...... . r ........ .. .
<br />IMPORTANT:If the holder is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to
<br />the terms and conditions of the polilcy, 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 />COMENTACT Karen Barry
<br />NA
<br />USI Northwest
<br />PHONE — FAX
<br />(,VC�N � -8390
<br />N E.t)� 503 224 610 362-8130
<br />700 NE Multnomah, Suite 11300
<br />-111, _1
<br />E-MAIL
<br />ADDRESS: karen.barry@usi.biz
<br />Portland, OR 97232
<br />---
<br />503 22
<br />INSURER($) AFFORDING RDING COVERAGE NAIL #
<br />INSURER A: Charter Oak Fire Insurance Comp
<br />25615
<br />INSURED
<br />INSURER 8 , Travelers Property Casualty Ins
<br />3-6-16"1
<br />Alta Planning + Design, Inc,
<br />INSURER C, Travelers Indemnity Company
<br />25658
<br />711 SE Grand Avenue A-2015-011 RE y IEWED BY:
<br />INSURER SAIF Corporation
<br />PERSONAL & ADV INJURY
<br />" A_ .
<br />Portland, OR 97214 41 - 1–
<br />jNSURER E: Zurich American Ins. Co.
<br />16535
<br />EUNICE HEREDIA (PG 1 OF 7)
<br />INSURERF, Continental Casualty Company
<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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED, BY THE POLICIES DESCR8ED HEREIN IS SUBJECT TO ALL THE TERMS,
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />_ J.Aba § 1. .1111, — - . . . ........
<br />INSR SD BR. _ ' i55L1CYEFF POLICY UTR TYPE OF INSURANCE INSR POLICY NUMBER. LIMITS
<br />(MMlDDNYYY)
<br />A
<br />GENERAL
<br />LIABILITY
<br />680813259484
<br />07/0112015
<br />07/01/2016
<br />EACHOCCURRENCE
<br />$2,000,000
<br />X
<br />13
<br />COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE F�vl
<br />I AI OCCUR
<br />680813259331
<br />07!01!201' S
<br />07/01/2016
<br />DAMAGE TO RENTED
<br />PREWSES(Eaoccurrence) —
<br />$1,000,000
<br />MED EXP (Any one person)
<br />$ 10,0:00
<br />PERSONAL & ADV INJURY
<br />$2,000,000
<br />...........
<br />GENERAL AGGREGATE
<br />$4,000,000
<br />GENL AGGREGATE LIMIT APPLIES PER:
<br />-1
<br />PRODUCTS - COMPJOP AGG
<br />s4,000,000
<br />IRI-
<br />POUCYF7X JECT [::] LOD
<br />$
<br />B
<br />AUTOMOBILE
<br />LIABILITY
<br />BA7A574417
<br />07/0112015
<br />07101/2016
<br />COMBINED _SINGLE LIMIT
<br />_JEg accident)
<br />$1,00 .. 0 .. 000
<br />7x
<br />ANY AUTO
<br />BODILY INJURY (Per person)
<br />$
<br />ALL OWNED SCHEDULED
<br />AUTOS AUTOS
<br />BODILY INJURY (Per accident}
<br />$
<br />Xi
<br />'ON-OWNED
<br />HIRED AUTOS AUTOS
<br />PROPERTY DAMAGE
<br />$
<br />C
<br />X
<br />UMBRELLA LIAR OCCUR
<br />CLIP813259933
<br />0710112015
<br />07101/2016
<br />. ........ . .
<br />EACH OCCURRENCE
<br />$5,000000
<br />EXCESS UAB CLAIMS-MADE
<br />AGGREGATE
<br />$5000,000
<br />DE1 I XJRETEITION$0
<br />D
<br />E
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY Y/N
<br />ANY PROPRIETOR/PARTNER/EXECUTIVE
<br />OFFICERIMEMBIER EXCLUDED?
<br />(Mandatory in
<br />NIA
<br />771940
<br />8997892
<br />WA Stop Gap - EL
<br />09101/2014
<br />09101/2014�1
<br />included
<br />09/01/201 5_X
<br />0910112015
<br />I&IITATI- CE)TR H-
<br />-, 11 T5?. I
<br />E.L. EACH ACCIDENT
<br />. .......
<br />S1 ,0011,'1100
<br />E L. DISEASE -EA EMPLOYEE $1,000,000
<br />If yes, dory under
<br />and
<br />DESCRIPTION OF OPERATIONS beYow
<br />OH Stop Gap - EL
<br />included
<br />—rrrr"
<br />E.L. DISEASE POLICY UNIT .$1,000,000
<br />F
<br />Professional
<br />MCH1 14135257
<br />07101/2015
<br />07101/2011�
<br />$3,0011,011 Per Claim
<br />Liability
<br />$4,000,000 Aggregate
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required)
<br />RE: Bicycle Safety Consultant Agreement, The City of Santa Ana, its officers, employees, agents, volunteers
<br />and representatives are included as Additional Insureds for General Liability and Auto Liability pursuant
<br />to written contract or agreement as provided by attached endorsements CGD3810907 and CAT4200710. Coverage
<br />applies on a primary and non contributory basis and is primary to other insurance that is available to the
<br />Additional Insured as required by written contract or agreement. Should described policies be cancelled
<br />(See Attached Descriptions)
<br />L,rK I IrIlLA I C NUILUCK
<br />The City of Santa Ana
<br />20 Civic Center Plaza - Ross
<br />Annex
<br />Santa Ana, CA 92701
<br />ACORD 25 (20'10/05) 1 of 2
<br />#S156647981M15662847
<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 />AUTHORIZED REPRESENTATIVE
<br />@ 1988-2010 ACORD CORPORATION. All rights reserved.
<br />The ACORD name and logo are registered marks of ACORD
<br />I F24 III IFA
<br />
|