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Ill CERTIFICATE OF LIABILITY INSURANCE
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<br />ATE
<br />D1130 I20 YY)
<br />11/30/2014
<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 />MOC Insurance Services
<br />License No. 0589960
<br />44 Montgomery St., 17th Fl.
<br />San Francisco CA 94104
<br />CONTACT Halidee Calle' as
<br />NAME: J
<br />PHONE . (415)957-0600 FAC 0.(415)957-0577
<br />IN
<br />A DD -MAIL hcallej as@mocins. com
<br />INSURERS AFFORDING COVERAGE NAIC#
<br />INSURER A:Citizens Ins. Co. of America 31534
<br />INSURED
<br />Keyser Marston Associates, Inc.
<br />160 Pacific Avenue, Suite 204
<br />San Francisco CA 94111
<br />INSURER e:Allmerica Financial Benefit Co. 41640
<br />INSURERC:Re ublic Indemnit 22179
<br />INSURERD:Evanston Insurance Co. 35378
<br />INSURER E:
<br />INSURER F:
<br />COVERAGES CERTIFICATE NUMBER:2014-2015 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 />INSR
<br />LTR
<br />TYPE OF INSURANCEJum
<br />ADDL
<br />SUBR
<br />BUMPOLICYNUMBER
<br />Executive Director of CDA
<br />POLICY EFF
<br />MMIDDIVYYY
<br />POLICY EXP
<br />MMIDDNYVV
<br />LIMITS
<br />GENERAL LIABILITY
<br />Halidee Callej as/HCA
<br />EACH OCCURRENCE $ 1,000,000
<br />PREMISES Eaoccurrence $ 500,000
<br />A
<br />X COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE ®OCCUR
<br />X
<br />BFA49104900
<br />12/1/2014
<br />12/1/2015
<br />MED EXP (Any one person) $ 10,000
<br />PERSONAL &ADV INJURY $ 1,000,000
<br />o Deductible Applies
<br />GENERAL AGGREGATE $ 2,000,000
<br />GEN'L AGGREGATE
<br />LIMIT APPLIES PER',
<br />PRODUCTS - COMPIOP AGS $ Included
<br />POLICY
<br />FX] "o -ECT LOC
<br />$
<br />AUTOMOBILE LIABILITY
<br />Ea BINEDt SINGLE LIMIT 1,000,000
<br />BODILY INJURY (Per person) $
<br />B
<br />X ANY AUTO
<br />ALL OWNED SCHEDULED
<br />AUTOS AUTOS
<br />X
<br />WFA49004900
<br />12/1/2014
<br />12/1/2015
<br />BODILY INJURY (Per accident) $
<br />Perr PROPERTYtDAMAGE $
<br />X HIRED AUTOS X AUTOS ED
<br />Uninsured motcUst combined $ 1,000,000
<br />X Curl$500 X Coll$500
<br />X
<br />UMBRELLA LIABX
<br />OCCUR
<br />EACH OCCURRENCE $ 4,000,000
<br />AGGREGATE $ 4,000,000
<br />A
<br />EXCESS LASCLAIMS-MADE
<br />DED X RETENTION$ N/
<br />$
<br />X
<br />UHFA49117100
<br />12/1/2014
<br />12/1/2015
<br />G'
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY YIN
<br />ANY PROPRIETOR/PARTNERIEXECUTIVE
<br />X I WC STATU- O
<br />TIN -
<br />E.L. EACH ACCIDENT_ $ 1,000,000
<br />OFFICERIMEMBER EXCLUDED? 0
<br />(Mandatory In NH)
<br />NIA
<br />039546-20
<br />12/1/2014
<br />12/1/2015
<br />_
<br />E.L. DISEASE - EA EMPLOYEEI $ 1,000,000
<br />If as, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE -POLICY LIMIT 1 $ 1,000,000
<br />D
<br />Professional Liability
<br />0658622
<br />12/1/2014
<br />12/1/2015
<br />Each Wrongful Act $1,000,000
<br />Retention $25,000
<br />tro Cage: 11/11/1976
<br />AGGREGATE LIMIT $2,000,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required)
<br />City of Santa Ana, City of Santa Ana Acting as Successor Agency and/or Housing Authority of the City of
<br />Santa Ana, its officers, employees, agents, volunteers and representatives are Additional Insured with
<br />respects to the Insured's operations. Insurance provided is Primary and is not contributory with any
<br />other insurance carried. 30 Day Notice of Cancellation/10 Day for nonpayment of premivm.�
<br />CERTIFICATE HOLDER CANCELLATION
<br />ACORD 25 (2010/05)
<br />1 NS025 (201005).01
<br />© 1988.2010 ACORD CORPORATION. All rights reserved.
<br />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 />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />City of Santa Ana
<br />Executive Director of CDA
<br />AUTHORIZED REPRESENTATIVE
<br />20 Civic Center Plaza M-25
<br />Santa Ana, CA 92701
<br />Halidee Callej as/HCA
<br />ACORD 25 (2010/05)
<br />1 NS025 (201005).01
<br />© 1988.2010 ACORD CORPORATION. All rights reserved.
<br />The ACORD name and logo are registered marks of ACORD
<br />
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