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GILL&PA-01 ROSEM
<br />� �� m CERTIFICATE OF LIABILITY INSURANCE
<br />�*^W"""��-
<br />DATDIYYYY)
<br />$1116121612016
<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 pollcy(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 €n lieu of such endorsement(s).
<br />PRODUCER License # OE67768
<br />IOA Insurance Services
<br />4360 La Jolla Village Drive
<br />Suite 900
<br />San Diego, CA 92122
<br />NAME: T Erica Wilson
<br />PHONE
<br />[xt : (619) 574W6220 as No ; (619)..674-6288
<br />aooRl� ss: Erica.Wllson@ioausa.com
<br />INSURERS AFFORDING COVERAGE
<br />_
<br />NAICff
<br />INSURERA: RLI Insurance Company
<br />13056
<br />PSB0001119
<br />INSURED
<br />INSURER B: Atlantic Specialty lnsurance,Company
<br />27154
<br />INSURERC:
<br />Gillis & Panichapan Architects, Incorporated
<br />INSURER D:
<br />2900 Bristol St. Suite G205
<br />Costa Mesa, CA 92625
<br />_
<br />INSURER 6:
<br />INSURER F:
<br />MED EXP (Any one person) $ 10,000
<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 CONTRACTOR 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 />ILTR
<br />TYPE OF INSURANCE
<br />D
<br />POLICY NUMBER
<br />POLICY EFF
<br />MMIODIYYYY
<br />POLICY EXP
<br />MMIDDNYVY
<br />v
<br />LIMITS
<br />A
<br />X COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE ® OCCUR
<br />X
<br />PSB0001119
<br />07/24/2016
<br />07/24/2017
<br />EACH OCCURRENCE $ 2,000,000
<br />PRM 9EAMAGETO a occurrence $ 1,000,000
<br />X Cont Llab/Sev of Int
<br />MED EXP (Any one person) $ 10,000
<br />s
<br />_
<br />PERSONAL &ADV INJURY $ - 2,000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />POLICY JECT LOC
<br />GENERAL AGGREGATE $ 4,000,00
<br />PRODUCTS -COMPIOPAGG $ 4,000,00
<br />FDeductlblo $
<br />OTHER:
<br />A
<br />AUTOMOBILE
<br />LIABILITY
<br />ANYAUTO
<br />PSA0001116
<br />06/01/2016
<br />06/01/2017
<br />COMBINED SINGLE LIMIT
<br />-Eaaceideytl1,000,000
<br />BODILYINJURY(Perperson)AUTOSNED
<br />JX
<br />AUTOSULEDBODILYINJURY(Peraccident)
<br />HIRED AUTOS NON-OWNEDAUTOS
<br />$1,000 Ix Coll.: $1,000
<br />$
<br />ParaccldentComp.,
<br />$
<br />UMBRELLA LIAR
<br />X
<br />OCCUR
<br />EACH OCCURRENCE $ 3,000,000
<br />A.
<br />X
<br />EXCESS LIAO
<br />-X
<br />CLAIMS -MADE
<br />PSEOOO1038
<br />07/2412016
<br />07/2412017
<br />gGGREGATE $ 3,000,000
<br />DED RETENTION$ 0
<br />$
<br />A
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY
<br />ANY PROP RI ETORIPARTNE R/EXECUTIVE Ya
<br />OFFICERIMEM13ER EXOLUDED7
<br />(Mandatory in NH)
<br />If yyes OmnThe under
<br />DESCi RIPTON OF OPERATIONS below
<br />NIA
<br />PSW0001177
<br />09/0112016
<br />09/01/2017
<br />x FPES� OTH-
<br />STATUTE ER
<br />__
<br />•F _FACkLAC.CIOEK'C
<br />E.L. DISEASE - EA EMPLOYEE $ 1,000,000
<br />E.L. DISEASE - POLICY LIMIT $ 1,000,000
<br />B
<br />Prof Liab/Clms Made
<br />DPL474716
<br />11/08/2015
<br />11/08/2016
<br />Per Claim 2,000,000
<br />B
<br />Ded.: $6k Per Claim
<br />DPL474715
<br />11/08/2016
<br />11/08/2016
<br />Aggregate 2,000,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more spaco is requlmd)
<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 Premium In accordance with the policy provisions.
<br />REV€EWED BY: EUNICE HEREDIA (PG OF Z )
<br />The City of Santa Ana
<br />Attn: Michelle Walker
<br />20 Civic Center Plaza M-36
<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
<br />UU THH~ORIZED/REPRESENTATIVE
<br />©1988.2014 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD
<br />
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