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GILL&PA-01 ROSEM
<br />LX
<br />CERTIFICATE OF LIABILITY INSURANCE
<br />DATE (MM'IDOfYYYY)
<br />11/612015
<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(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 #f` OE..6 x7'67$
<br />IOA Insurance Services
<br />4350 La Jolla Village Drive
<br />Shite 900
<br />CONTACT
<br />Erica �IiiSfJn
<br />PHONE (619 574-6220 FAX (619) 574-6281$
<br />A/C N ExI : aID, NC :
<br />A DRIE55: Erica.WIIs6niQaUsa.ct7m
<br />San Diego, CA 92.122
<br />INSURERS) AFFORDING COVERAGE NAIL 4
<br />INSURER A: RLI Insurance Company 13056
<br />PSB0001119
<br />INSURED
<br />INSURER, a., 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 />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 />INSR
<br />LTR
<br />I TYPE OF INSURANCE
<br />ADDL
<br />INSID
<br />UBR
<br />WVDPOLICY
<br />NUMBER
<br />POLICY EFF
<br />M.MPDDIYYYY
<br />POLICY EXP
<br />MMIDD!'YYYY
<br />LIMITS
<br />A
<br />X COMMERCIAL .GENERAL LIABILITY
<br />CLAIMS -MADE X OCCUR
<br />X
<br />PSB0001119
<br />07/24/2015
<br />0712412016
<br />EACH OCCURRENCE ''. $ 2,000,00.
<br />DAMTO RETED
<br />PREM8ES Eauccurrence) ''., $ 1,000,00
<br />X Cont LabdSev of Int
<br />MED EXP (Anyone person) S 10,000
<br />PERSONAL & ADV INJURY $ 2,000,00'
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />POLICY F7X ECT LOC
<br />GENERAL AGGREGATE $ 4,000,00..
<br />PR04UCTS - C®MIPf�C7P AGG $ 4,000,0'0.
<br />Deductible $
<br />OTHER:
<br />AUTOMOBILE
<br />LIABILITY
<br />I COMBINED SINGLE LIMIT $ 1,000,00
<br />Ea accident
<br />A
<br />X
<br />ANY AUTO
<br />PSA0001116
<br />06/01:/2015
<br />0610112016
<br />1 BODILY INJURY (Per person) $
<br />ALL OWNED SCHEDULED
<br />. AUTOS AUTO'S
<br />BODILY INJURY (Peraccideml)
<br />NON-OWNED
<br />HIRED AUTOS.IxAUTOS
<br />PROPERTY DAMAGE
<br />'.. Reraccldent
<br />X
<br />Cnmpd$1,0001 Coll!$1,000
<br />$
<br />X
<br />UMBRELLA LIAB
<br />[XI
<br />OCCUR
<br />EACHOCCURRENCE $ 3,000,00
<br />AGGREGATE $ 3,000,00
<br />A
<br />EXCESS LIAR
<br />CLAIMS -MADE
<br />PSE0001038
<br />07/2412015
<br />0712412016
<br />:D:E:D:1:K RETENTION $ 0
<br />$
<br />A
<br />WORKERS COMPENSATIONX
<br />AND EMPLOYERS' LIABILITY
<br />ANY PROPRIETORIPARTNERrEXECUTIVE YIN
<br />OFFICERIMEMBER EXCLUDED? ❑
<br />(Mandatory in NH)
<br />It yres, descriibe under
<br />DESCRIPTION OF OPERATIONS below
<br />N d A
<br />PSW0001177
<br />09/0,1/2015
<br />09/01/2016
<br />PER OTH-
<br />STATUTE.. ER
<br />E.L. EACH ACCIDENT $ 1,000,00
<br />E.L. DISEASE - FA EMPLOYEE $ 1,000,00
<br />F.L. DISEASE -POLICY LIMIT $ 1,000,00
<br />B
<br />Prof Lab/Clens Made
<br />DPL474715
<br />11/0812015
<br />11/0812016
<br />Per Claim 2,000,00
<br />B
<br />Ded.: $5k Per Claim
<br />DPL474715
<br />11/0812015
<br />1110812016
<br />Aggregate 2,000,00
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I 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 Non -Payment of Premium in accordance with the policy provisions.
<br />ry.__ � .,.
<br />I'�f::SII„"f.-6-.1 &I I L�Y`rli� L I-II �,Hl:7E��'I (PG «I'= � !
<br />CERTIFICATE HOLDER CANCELLATION
<br />ACORD 25 (20144101)
<br />@ 1988-2014 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 />AUTHORIZED REPRESENTATIVE
<br />Clerk of the City Council]
<br />20 Civic Center Plaza (M-30)
<br />P.O.
<br />P.O. Box 1988
<br />—T—
<br />Ana, CA 92702
<br />ACORD 25 (20144101)
<br />@ 1988-2014 ACORD CORPORATION. All rights reserved.
<br />The ACORD name and logo are registered marks of ACORD
<br />
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