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Client#: 835015 ALTAPLAN
<br />CERTIFICATE OF LIABILITY INSURANCE DATE IMMMDNYYY)
<br />1 12/2212015
<br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER, THIS
<br />CERTIFICATE DOES NOT AFFIRMATlVELY 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 />IMPORTANT: If the certificate holder is an ADDITIONAL INSURIED, the Policy(ies) must be endorsed. If SUBROGATION IS WA-1VED,B"uGj-ect 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 NA" T Karen Barry
<br />C
<br />USIl Northwest CF�A X-,— - -
<br />P 503 224-8390 '10 362-8130
<br />700 NE Multnomah, Suite 1300 -(A E1,Q:1 - - -s; . biz
<br />_A, 5, karen.barry@u i
<br />Portland, OR 97232
<br />503 -8390
<br />INSURER(S) AFFORDING COVERAGE NAIC
<br />224
<br />INSURER A, Charter Oak Fire Insurance Co. 25615
<br />INSURED
<br />Alta Planning + Design, Inc.
<br />711 SE Grand Avenue
<br />Portland, OR 97214
<br />INSURER B:
<br />Travelers Property Casualty Ins
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
<br />36161
<br />INSURER C:
<br />Travelers indemnity Company
<br />GENERAL LIABILITY I 680813259484
<br />25658
<br />INSURER 0:
<br />SAIF Corporation
<br />B
<br />36196
<br />INSURER E:
<br />Zurich American Ins. Co,
<br />$1,000,000
<br />$10,000
<br />16535
<br />INSURER F:
<br />Continental Casualty —Company -"""----",-
<br />PERSONAL & ADV INJURY
<br />20443
<br />COVERAGES CERTIFICATE NLJMRER,! Pr-vl-qlnm NI 1URPIP.
<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. NOTWITHSIANDING 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 />INSR CE ADDL SUBR POLICY EFF PdUc'Y tXo
<br />TYPE OF INSURAN
<br />LTR . .. ........ -- JNSR WVDi POLICY NUMBER (MMfDDfYYYY LIMITS
<br />MM
<br />A
<br />GENERAL LIABILITY I 680813259484
<br />07/0112015
<br />---Ft2,0li6,000
<br />07101/201 EACH OCCURRENCE
<br />B
<br />X COMMERCIAL GENERAL LIABIL17Y 1 1 680813259331
<br />------ - CLAIMS-MADE Fy� OCCUR
<br />07/01112015
<br />AMAGE T ENT17D
<br />07101/201 ,PREMISES a occ
<br />HIED EXP {Any 3ne per,,on)
<br />$1,000,000
<br />$10,000
<br />PERSONAL & ADV INJURY
<br />12,000,000
<br />GENFRAL AGGREGATE
<br />s4,000,000
<br />_2ENT- AGGREGATE LIMIT APPLIES PER
<br />-7X
<br />'PRODUCTS - COMPrOFAGG
<br />s4,000,000
<br />"0-
<br />POLICY [ JECT LOf
<br />B
<br />AUTOMOMLE LIAMLITY BA7A5744117
<br />0710112015
<br />COMBINED GNGLE LiMIT
<br />071011201
<br />1 1,000,000
<br />X ANY AUTO
<br />BODILY WJURY QPer ppuson),
<br />$
<br />ALL OWNED SCHEDULED
<br />AUTOS AUTOS
<br />BODILY INJURY qPeF JCCKiellf)
<br />$
<br />X NON-OVVNED
<br />X HIRED AUTQ9 AUTO$
<br />PROPERTY DAMAGE
<br />OQQ cjand — - ---------
<br />$
<br />. .... - -----
<br />-
<br />{
<br />$
<br />C
<br />.. .... .......... .......
<br />X UMBRELLALIAB O'CUR r CUP88259933
<br />0710112015
<br />07101/2016 EACH OCCURRENCE
<br />$5,000,000
<br />EXCEss LIAII 1, rsNUt
<br />I ACK,,RFGATE
<br />351Q991000
<br />D ED X� RETENTION$10,000
<br />F
<br />D
<br />WORKERS COMPENSATION 7719,40
<br />0910112015
<br />09/01/201 I
<br />E
<br />AND EMPLOYERS'LIABILITY
<br />ANY PROPRiFTOR)PARTNF1 - IN� 18997892
<br />1�)RY LIMITS
<br />-L-
<br />,/FXE( UFr/EL
<br />OFFICER)MENIBER EXCLUDE y NIA
<br />y
<br />0910112015
<br />0910'1/20'1��E.L.�EAC�,,IACC�DENT
<br />0
<br />1,000�0 0
<br />s'1,000,000
<br />(Mandatory in NH) WA Stop Gap -EL
<br />Included
<br />11 E.L.DISEASE - EAENIPL YE
<br />If yes, d Cl ba undpr
<br />t.L-:fjP 1 OH Stop Gap -EL
<br />included
<br />I
<br />EJ-. D�SEASE F 1,51,000,000
<br />F
<br />Professional MCHI 14135257
<br />0710112015
<br />_�lMj
<br />0710'1/201 $3,000,000 Per Claim
<br />Liability
<br />1! $4,000,000 Aggregate
<br />DESCRIPTION OF OPERATIONS I LOCATIONS' ) VEHICLES (Attach ACORD 101, Additional Rewrks Schedule, if mare spare is requiredI
<br />RE!: City of Santa Ana, its officers, employees, agents, volunteers and representatives are Additional
<br />Insureds for General Liability When required by written contract or agreement as to extent provo-decl by
<br />attached endorsement CGD3810907. Coverage applies on a primary and noncontributory basis as required by
<br />written contract or agreement. Should described policies be cancelled before the expiration date thereof,
<br />the issuing company will rnafl 30 days advance written notice to the g�rjffirfiLo.�PVhjder p
<br />lnrjgj�
<br />nonpayment and Workers Compensation. REVIEWED BY: Z,`
<br />CERTIFICATE HOLDER
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />City of Santa Ana THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />201 Civic Center Plaza (M-30) ACCORDANCE WITH THE POLICY PROVISIONS,
<br />P�O. Box 1988
<br />Santa Ana, CA 92702-1988 AUTHORIZED REPRESENTATNE
<br />1988-2010 ACORD CORPORKNON. Ali rights roserved.
<br />ACORD 25 (2010/05) 1 of 'I The ACORD nanne and logo 'rare registered rnarks of ACORD
<br />#S'I 6911,1388IM1 6854436 SUPZF1
<br />
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