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GILL&PA-01 ROSEM
<br />A R® CERTIFICATE OF LIABILITY INSURANCE
<br />DAT5/129/20152912015 V)
<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 andorsement s .
<br />PRODUCER License # OE67768
<br />IOA Insurance Services
<br />4350 La Jolla Village Drive
<br />Suite 900
<br />San Diego, CA 92122
<br />CONTACT Erica Wilson
<br />_
<br />PHONE fS19 574-6220 FAX
<br />c gsy);( ) AIc No: (619) 574-6288
<br />,,,
<br />EMAIL Ei(C WIISoIT oausa.COITT
<br />ADDRESS:
<br />LIMITS
<br />A
<br />INBUREft $) AFFORDING COVERAGE NAIC U
<br />INSURER A: RLI Insurance Company 13056
<br />INSURED
<br />INSURERS; Atlantic Specialty Insurance Company 27154
<br />INSURERc:
<br />Gillis& Panichapan Architects, Incorporated
<br />INSURER D
<br />2900 Bristol St. Suite 6205
<br />Costa Mesa, CA 92626
<br />INsufteR E:
<br />INSURER F:
<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 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 />/LTR
<br />TYPE OF INSURANCE
<br />DD
<br />5
<br />POLICY NUMBER
<br />POLICYEFF
<br />MMIOOIYYVV
<br />LIMITS
<br />A
<br />X COMMERCIAL GENERAL LIABILITY
<br />cIAIMB-MADE OCCUR
<br />PSB0001119
<br />0712412014
<br />07/24/2015
<br />EACH OCCURRENCE $ 2,000,00
<br />PREMISES Ea occurrence $ 1,000,00
<br />X Cont Liab/Sev of Int
<br />MED CXP (Anyone person) $ 10,000
<br />X Ded.:$0
<br />PERSONAL& ADV INJURY $ 2,000,00
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />POLICY® jRCOT F LOC
<br />GENERAL AGGREGATE $ 4,000,00
<br />PRODUCTS - COMP/OP AGG $ 4,000,00
<br />$
<br />OTHER:
<br />AUTOMOBILE
<br />LIABILITY
<br />COMBINED SINGLELIMIT $ 1,000,00
<br />Ea accident
<br />A
<br />X
<br />ANYAUTO
<br />PSAOOOII16
<br />06101/2015
<br />06/01/2016
<br />BODILY INJURY (P., denser) $
<br />ALL OWNED SCHEDULED
<br />AUTOS AUTOS
<br />BODILY INJURY jeer accident 1 $
<br />X
<br />NON -OWNED
<br />HIRED AUTOS AS
<br />Compl$1,D00 X Ca1151,000
<br />PROPERTY DAMAGE $
<br />Paraccltlen
<br />$
<br />UMBRELLA LIAR
<br />X
<br />OCCUR
<br />EACH OCCURRENCE $ 3,000,000
<br />A
<br />IX
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />PSE0001038
<br />07124/2014
<br />07/2412015
<br />AGGREGATE $ 3,000,000
<br />DED I X I RETENTION$ 0
<br />$
<br />A
<br />WORKERS COMPENSATION
<br />EMPLOYERS' LIABILITY
<br />ANY PROPRIETORIPARTNERIEXECUTIVE VIN
<br />OFFICERIMEMBER EXCLUDED?
<br />NIA
<br />PSW0001177
<br />09101/2014
<br />09101/2015
<br />PER OE
<br />X STATUTE E
<br />E.L. EACH ACCIDENT $ 1,000,00
<br />A E
<br />E.L. DISEASE - EMPLOYE $ 1,000,000
<br />(Mandatory in NH)
<br />I! yes, tlescnbe antler
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE -POLICY LIMB 1 $ 1,000,000
<br />B
<br />Prof Liab/Clms Made
<br />DPL386914
<br />11108/2014
<br />11108/2015
<br />Per Claim 2,000,000
<br />B
<br />Ded.: $5k Per Claim
<br />�DPL386914
<br />11108/2014
<br />1110812015
<br />Aggregate 2,000,000
<br />DESCRIPTION OF OPERATIONS /LOCATIONS 1 VEHICLES (ACOR0101, Addltlonal Remarks Schedule, may he attached If more space is requirad)
<br />Re: All Operations
<br />The City of Santa Ana is Additional Insured with respect to General Liability per the attached endorsement as required by written contract.
<br />30 Days Notice of Cancellation with 10 Days Notice for Non -Payment of PremJi "m in a orda ce with the policy provisions.
<br />GILLIS & PANICHAPAN ARCHITECTS, INC. REVIEWED BY: �//� �' EUNICE HEREDIA (PG 1 OF 2)
<br />CERTIFICATE HOLDER CANCELLATION
<br />ACORD 25 (2014/01)
<br />©19882014 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 />Clerk of the City Council
<br />20 Civic Cantor Plaza (M-30)
<br />P.O. Box 1988
<br />AUTHORIZED REPRESENTATIVE
<br />Santa Ana CA 92702
<br />ACORD 25 (2014/01)
<br />©19882014 ACORD CORPORATION. All rights reserved.
<br />The ACORD name and logo are registered marks of ACORD
<br />
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