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GILL&PA-01 L.YN <br />A Hca► CERTIFICATE OF LIABILITY INSURANCE DATE <br />A E[MM2016YY) <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 have ADDITIONAL INSURED provisions or be endorsed. <br />If SUBROGATION IS WAIVED, subject to the terms and conditions <br />of the policy, certain policies may require an endorsement. A statement on <br />this certificate does not confer rights to the certificate holder in lieu <br />of such endorsement(s). <br />License # OE67768 <br />CONTACT Erica Wilson <br />PRODUCER <br />NAME: <br />IOA Insurance Services <br />PHONE FAX <br />(AIC, No, Ext): (858) 754-0063 50233 (A/C, No): <br />4350 La Jolla Village Drive <br />EACH OCCURRENCE S <br />Suite 900 <br />ADDRESS: Erica.Wilson@ioausa.com <br />San Diego, CA 92122 <br />1,000,000 <br />X Cont Liab/Sev of Int <br />INSURER(S) AFFORDING COVERAGE NAIC # <br />10,000 <br />INSURER A: RLI Insurance Company 13056 <br />INSURED <br />INSURER B: Atlantic Specialty Insurance Company 27154 <br />Gillis & Panichapan Architects, Incorporated <br />INSURER C <br />2900 Bristol St. Suite G205 <br />INSURER 0 <br />Costa Mesa, CA 92626 <br />GEN'L AGGREGATE LIMI T APPLIES PER. <br />INSURER E <br />4'000,000 <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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO <br />WHICH THIS <br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL <br />THE TERMS, <br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE <br />BEEN REDUCED BY PAID CLAIMS. <br />INSR TYPE OF INSURANCE ADDL SUER POLICY NUMBER <br />LTR INSD WVD <br />POLICY EFF POLICY EXP LIMITS <br />MMIDD/YYYY� M(MM/DDIY YY <br />20 Civic Center Plaza M-36 <br />A X COMMERCIAL GENERAL LIABILITY <br />EACH OCCURRENCE S <br />2,000,000 <br />CLAIMS -MADE X OCCURPSBOOO1119 <br />X <br />07/24/2016 07/24/2017 DAMAGE TO RENTED <br />PREMISES (Ea occurrence) S <br />1,000,000 <br />X Cont Liab/Sev of Int <br />10,000 <br />MED EXP (Any one person) $ <br />2'000,000 <br />PERSONAL X ADV INJURY $ <br />GEN'L AGGREGATE LIMI T APPLIES PER. <br />GENERAL AGGREGATE $ <br />4'000,000 <br />POLICY X PRO LOC <br />PRODUCTS - COMP/OPAGG $ <br />4'000,000 <br />Deductible <br />0 <br />OTHER. <br />$ <br />A AUTOMOBILE LIABILITY <br />COMBINED SINGLE LIMIT <br />(Ea accident) $ <br />1,000,000 <br />X ANY AUTO PSA0001116 <br />06/0112016 06/01/2017 BODILY INJURY (Per person) $ <br />OWNED SCHEDULED <br />AUTOS ONLY AUTOS <br />BODILY INJURY (Per accident) S <br />AUTOS ONLY ATOS ONLDY <br />PROPERTY DAMAGE S <br />Per accident <br />X Comp." $1,000 X Colla $1.000 <br />A UMBRELLA LIAB X OCCUR <br />_ EACH OCCURRENCE $ <br />3,000,000 <br />X EXCESS LAB CLAIMS -MADE PSE0001038 <br />07/24/2016 07/24/2017 AGGREGATE $ <br />3,000'000 <br />DED X RETENTION $ 0 <br />S <br />_ <br />A WORKERS COMPENSATION e <br />X PER OTH- <br />STATUTE ER <br />AND EMPLOYERS' LIABILITY <br />YIN PSW0001177 <br />09/01/2016 09/01/2017 <br />1,000,000 <br />ANY PROPRIETOR/PARTNER/EXECUTIVE <br />NIA <br />E.L. EACH ACCIDENT $ <br />pFFICERIMQMBER EXCLUDED? <br />NH) <br />11000,000 <br />(Mandatory in <br />E.L. DISEASE - EA EMPLOYEE $ <br />If yes describe under <br />1,000,000 <br />DESCRIPTION OF OPERATIONS below <br />E.L. DISEASE -POLICY LIMIT $ <br />B Prof Liab/Clms Made DPL597016 <br />11/08/2016 11/08/2017 Per Claim <br />2,000,000 <br />B Ded.: $5k Per Claim OPL597016 <br />11108/2016 11/08/2017 Aggregate <br />2,000,000 <br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, <br />may be attached if more space is required) <br />Re: All Operations <br />The City of Santa Ana is Additional Insured with respect to General Liability per <br />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 />_ <br />REVIEWED BY_ EUNICE HEREDIA (F`G) OF �� ) <br />CERTIFICATE HOLDER CANCELLATION <br />ACORD 25 (2016103) © 1988-2015 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 />The City of Santa Ana <br />__..___... <br />AUTHORIZED REPRESENTATIVE <br />Attn: Michelle Walker <br />20 Civic Center Plaza M-36 <br />� � � <br />P.O. Box 1988 <br />• <br />Santa Ana, CA 92702-1988 <br />ACORD 25 (2016103) © 1988-2015 ACORD CORPORATION. All rights reserved. <br />The ACORD name and logo are registered marks of ACORD <br />