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<br />CII_.! IC & FANIChiAPLON ARCH., INC AiO-1711-?G)'I �a 18 REIEWEI fY "
<br />"" EUNICE HEREDIA (PG 1 OF 3)
<br />GILL&PA-01 ROSEM
<br />AoC"J?"TE
<br />CERTIFICATE OF LIABILITY INSURANCE
<br />(MM)DDNYYY)
<br />13/14/2015
<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 pol'ocy(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 License # OE67768
<br />IO'A Insurance Services
<br />4350 La Jolla Village Drive
<br />Suite 900
<br />San Diego, CA 92122
<br />CONTACT
<br />NAME. Erica Wilson
<br />PHONEFAX
<br />o Ext): (619) 574-622'0 AIC Noj: (619) 574-5208
<br />[AJCNo,
<br />E-MAILErica. VWilsonioausa.com
<br />ADDRESS:
<br />LIMITS
<br />A
<br />INSURERS) AFFORDING COVERAGE MAIC II.
<br />INSURER A: RLI Insurance Company 13056
<br />INSURED
<br />INSURER B: Atlantic Specialty Insurance Company 27154
<br />INSURER C:
<br />Gillis & Panichapan Architects, Incorporated''
<br />INSURER D
<br />2900 Bristol St. Suite G205
<br />Costa Mesa, CA 92626
<br />INSURER E
<br />LIN SURER F
<br />COVERAGES CERTIFICATE NUMBER, REVISION NUMBER:
<br />THIS IS TO CERTIFY THAT THE POLICIIES 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 ISSiUED 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 />tNISRY
<br />LTR
<br />TYPE OF INSURANCE
<br />ADD
<br />UBR.
<br />POLICY NUMBER
<br />EFF
<br />(MMIDDNYY"Y
<br />MRMiDPOLICY EXIP
<br />DPYYYY
<br />LIMITS
<br />A
<br />X COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE T OCCUR
<br />X
<br />PSB0001119
<br />0712412015
<br />071241201.6DAMAGE
<br />EACH OCCURRENCE $ 2,000,000
<br />70 RE71,001E 0
<br />PREMISES Ea occurrence $ a 00
<br />X Cont LiablSev of Int
<br />MED EXP (Any one person) $ 10,000
<br />PERSONAL & ADV INJURY $ 2,000,000
<br />GEN'LAGGREGATE LIh1ITAPPLIES PER:
<br />POLICY � E d LOC
<br />GENERAL AGGREGATE $ 4,000,000
<br />PRODUCTS - COMPTOIP AGG $ 4,000,000
<br />Deductible $ 0
<br />OTHER:
<br />AUTOMOBILE
<br />LIABILITYO
<br />aBINED SidriINGLE LIMIT $ 1,t�00.. 000
<br />A
<br />X
<br />ANY AUTO
<br />PSA00@1116
<br />06101/2.'015
<br />06/0112016
<br />BODILY INJURY (Per person) $
<br />ALL 04MNE0 SCHEDULED
<br />AUTOS AUTOS
<br />BODILY INJURY Per accident $
<br />l I
<br />X
<br />NON -OWNED
<br />HIRED AUTOS AUTOS
<br />COmp!$1,000 X COIi!$1,000
<br />(PROPERTY DAMAGE $
<br />Per accident
<br />X.
<br />UMBRELLA LIIAS
<br />X.
<br />OCCUR
<br />EACH OCCURRENCE. $ 3,000,000'
<br />A
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />PSE0001038
<br />017/2412015
<br />07/2412016
<br />AGGREGATE $ 3,000,000'
<br />UEU X I RETENTION $ 0
<br />$
<br />A
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' (LIABILITY
<br />ANY PROPRIETOR/PARTNERIEXECUTIVE Y P N
<br />OFFICER/MEMBER EXCLUDED?
<br />N f A
<br />PSVi10001177
<br />09'101/2015
<br />09/01/2016
<br />ASPER
<br />TATUTE
<br />._
<br />E.L. EACH ACCIDENT $ 1,000,000
<br />E.L. DISEASE - EA EMPLOYE'. $ 1,000,000
<br />(Mandatoryin NCH)
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE -POLICY LIMIT $ 1,000,000
<br />B
<br />Prof Liab/Clens Made
<br />DPL386914
<br />11/08/2014
<br />1110812015
<br />Per Claim 2,0010,000
<br />B
<br />Ded.: $5k Per Claim
<br />DPL386914
<br />11/08/2014
<br />11106/2015
<br />Aggregate 2,000,000
<br />DESCRIPTION OF OPERATIONS P LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
<br />Re: Agreement No.'s A-2005-275 (A-2008-011) and A-2015-118
<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 Nan -Payment of Premium in accordance with the policy provisions,
<br />CERTIFICATE HOLDER CANCELLATION
<br />City of Santa Ana
<br />Clerk of the City Council
<br />20 Civic Center Plaza (M-30)
<br />P.O, Box 1988
<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 />91988-2014 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2014101') The ACORD name and logo are registered' marks of ACORD
<br />
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