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ACOR" CERTIFICATE OF LIABILITY INSURANCE
<br />�.....-''"
<br />DATE (MM/DDIYYYY)
<br />Fi/27/2016
<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
<br />Dealey, Renton & Associates
<br />199 S Los Robles Ave Ste 540
<br />Pasadena, CA 91101
<br />CONTACT
<br />Marie Swaney
<br />FAX
<br />PHONE . 626 844-3070
<br />EMAIL DRESS, mswaney@dealeyrenton.com
<br />INSURERS AFFORDING COVERAGE NAIC #
<br />License #0020739
<br />INSURERA:Travelers Indemnity Co. of Connecti 25682
<br />680281 OL758
<br />INSURED CIVILSOUR
<br />INSURER B :Travelers Property Casualty Co of A 25674
<br />CivilSource, Inc.
<br />9890 Irvine Center Drive
<br />INSURER C :Travelers Casualty&Surety Co of Ame 31194
<br />MED EXP (Any one person) $10,000
<br />Irvine, CA 92618
<br />INSURER D
<br />INSURER E:
<br />949 585-0477
<br />INSURER F :
<br />COVERAGES CERTIFICATE NUMBER: 1638202879 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 />TYPE OF INSURANCE
<br />ADDLSUBR
<br />INSD
<br />WVD
<br />POLICY NUMBER
<br />POLICY EFF
<br />MM/DDIYYYY
<br />POLICY EXP
<br />MM/DDIYYYY
<br />LIMITS
<br />A
<br />X COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE ❑X OCCUR
<br />Y
<br />Y
<br />680281 OL758
<br />7/20/2015
<br />7/20/2016
<br />EACH OCCURRENCE $2,000,000
<br />DAMAGETO
<br />PREMISESSEa occurrence) $1,000,000
<br />MED EXP (Any one person) $10,000
<br />X Contractual Liab
<br />X XCU Included
<br />PERSONAL & ADV INJURY $2,000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />GENERAL AGGREGATE $4,000,000
<br />POLICY [ JECT F] LOC
<br />PRODUCTS - COMP/OP AGG $4,000,000
<br />$
<br />OTHER:
<br />B
<br />AUTOMOBILE
<br />LIABILITY
<br />Y
<br />BA45921_377
<br />7/20/2015
<br />7/20/2016
<br />COMBINED SINGLE LIMIT $
<br />Ea accident 1,000,000
<br />BODILY INJURY (Per person) $
<br />ANY AUTO
<br />ALL OWNED SCHEDULED
<br />AUTOS AUTOS
<br />BODILY INJURY $
<br />Per accident
<br />( )
<br />X
<br />HIRED AUTOS EX NON -OWNED
<br />AUTOS
<br />PROPERTY DAMAGE $
<br />Per accident
<br />$
<br />X
<br />NoOwnedAutos
<br />B
<br />X
<br />UMBRELLA LAB
<br />X
<br />IOCCUR
<br />Y
<br />Y
<br />CUP6772Y251
<br />7/20/2015
<br />7/20/2016
<br />EACH OCCURRENCE $1,000,000
<br />AGGREGATE $1,000,000
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />DED X RETENTION $0
<br />$
<br />B
<br />WORKERS COMPENSATION
<br />EMPLOYERS' LIABILITY Y / N
<br />ANY PRO PRIETOR/PARTNER/EXECUTIVE❑
<br />OFFICER/MEMBER EXCLUDED?
<br />NIA
<br />A
<br />y
<br />UB6771Y518 4
<br />7/20/2015
<br />7/20/2016X
<br />STATUTE
<br />STATUTE ER
<br />E.L. EACH ACCIDENT $1,000,000
<br />---
<br />E.L. DISEASE - EA EMPLOYEE $1,000,000
<br />(Mandatory in NH)
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE - POLICY LIMIT $1,000,000
<br />C
<br />Professional Liability
<br />105968526
<br />7/20/2015
<br />7/20/2016
<br />$2,000,000 Per Claim
<br />Claims Made Form
<br />$2,000,000 Annual Aggregate
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
<br />General Liability policy excludes claims arising out of the performance of professional services. Umbrella policy is a follow -form to underlying
<br />General/Hired&Non-Owned Auto/Employers Liability Policies.
<br />Re: A-2015-163 OnCall & A-2015-237 OnCall -- City of Santa Ana and their officers, agents and employees are named as additional
<br />insured as respects general and hired/non-owned auto liability for claims arising from the o rations of the named insured as required per
<br />waiver of subrogation per the attached endorsement(s). g p endorse Insurance coverage includes
<br />g p_.. r _
<br />written contract. Insurance includes rima an non-contributory 4Vwo�rdl�� BY-
<br />hattach end I l��ll� � I�p ILII I�W�� (PG
<br />� �y ()F )
<br />(r _ G
<br />V Crll Ir 11-iAiC nVLLJ CR UAINI r-LLAI IVIV ov Udy IV VISI IU Udy IU[ IVUI Ir-dy UI r'I eI II
<br />City of Santa Ana
<br />20 Civic Center Plaza
<br />Santa Ana CA 92701
<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 />©1988-2014 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD
<br />THIS CERTIFICATE SUPERSEDES PREVIOUSLY ISSUED CERTIFICATE
<br />
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