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EPIC LAND SOLUTIONS A-2015-161 REVIEWED BY
<br />EUNICE HEREDIA (PG 1 OF 5)
<br />EPIQLAN-PI ROSEM
<br />CERTIFICATE OF LIABILITY INSURANCE 1
<br />GATE (MMIDDIYYYY)
<br />811112015
<br />THIS CERTIFICATE IS ISSUED As A MATTER. OF INFORMATION ONLYAWCONFERS 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 Or INSURANCE DOES NOT CONSTITUTE A Q RACT BET-WEE I N I THE ISSUING INSURER(S), AUTHORIZED
<br />NOT - i , q
<br />REPRESENTATIVE OR Pkobucm, AND:tHE CE IRTIFICATEMOLDER,
<br />IMPORTANT.-: If thel certificato'holder Is an ADDITIONAL INSURED, the po I licy(les) must be endorsed. If SUBROGATION It WAIVED, subject to
<br />the terms and conditions of the policy, certain liql1cles may require an ohdorse'ment, A,staternent on this certificate does not conferrigots to the
<br />certificate holder In lieu of such.endorsement(s).
<br /># OE67768
<br />IOA InsuranceSerAces
<br />4350 La Jolla 'Village Drive
<br />Suite POO
<br />San Diego, CA 92122
<br />I T Erica Wilson
<br />NAME
<br />_NAME'
<br />PHONE FAX
<br />ol. IMC, No): (610) 57476288
<br />(AfC . Ext):
<br />MAIL
<br />EMAIL ErIq9.WII§qn@JoaUsa,cbM.
<br />INSURER(S) AFFORDING COVERAGE
<br />:NAIL*
<br />INSURER ANedley'TO rd 6 Instiranc 1 0, G,o,m P my
<br />20608
<br />INSURED
<br />Epic Land, Solutions
<br />2601 Airport Drive Suite 1.1,5
<br />Torrariqe, CA 90505
<br />- rt t ur�an,
<br />INsukiEka:Tra'nspo a i.on Ins Ce company
<br />20494
<br />MuI4Ekc:Columbia' Casualty Company
<br />31127
<br />INSURER 6,:
<br />INSURSRE.,
<br />$
<br />INSURERS :
<br />COVERAGES CERTIFICATE NUMBER: REVISION NUMBER;
<br />THIS' IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TOTHE INSURE ' D.NAMEDABOVE FOR THEPOLICY PERIOD
<br />INDICATED. NOTWITHSTANDING ANY RM.11REMENT, TERM , OR CONDITION- OF ANY CONTRACTOR: OTHER DOCUMENTWITH RESPECTTbvvHICH'THIS-
<br />CERTIFICATE: MAY BE ISSUED OR,MAY PERTAIN,. THE INSURANCE AFFORDED BYJHEPOLICIES DESCRIBED HEREIN Is SUBJECTTOALL THETERMS,
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES -;.LIMITS SH0VVN MAYHAVE BEEN REDUCED.BYPAID CLAIMS.
<br />INSR
<br />TYPE OF INSURANCE
<br />AVUL.
<br />INSD
<br />�SLAiKl
<br />WVD
<br />POLICYNUMBER
<br />P.DLIGYEFF
<br />(MM/DD[YY Y)
<br />POLICYEXP
<br />IMM DDYYYY1
<br />LIMITS
<br />.LTR1
<br />A
<br />X
<br />commERCIAL.. ENERALLIABILITY
<br />EACH OCCURRENCE
<br />$
<br />CLAIMS-10A DE OCCUR,
<br />4_031022253
<br />1.0/911/2414
<br />10,1011201,5
<br />�IJAIIIAI,1 IIJ
<br />PRE �S (F Oucun�mco)
<br />�MISF
<br />1,000,000
<br />MEDEXR(Anyonaperson)
<br />$ '10,000
<br />Cent Liab/Sev of Int
<br />X
<br />No C,q, Owned Autos
<br />PERSONAL & ADV INJJRY
<br />$ 2,000,00 o
<br />G I EN'I.AGGREGATEILIMITAPPLIESPER:
<br />POLICY M JPERCO
<br />T LOC
<br />GENERALAGGREGArE'
<br />$ 4000,000
<br />PRODUCTS-coMP& AGO
<br />$ 4000,000
<br />Deductible
<br />$
<br />OTHER:
<br />AUTOMoBiLE
<br />LIABILITY
<br />$0 M INEDSINQLE.L,IMIT
<br />$ 1,000,000
<br />A
<br />AUTO,
<br />403,10.2122.53
<br />101011120114.
<br />10/01/2015
<br />BODILY INJURY (Per person)
<br />$
<br />IANY
<br />X
<br />ALL QVMED SCHEDULED'
<br />AUTOS AUTOS'
<br />11 NO.N-0,MED
<br />HIRED AUTOS AUTOS
<br />BODILY INJURY I (Peraccident)
<br />$
<br />PROPERTY DAMAGE
<br />Per accident)
<br />$
<br />X
<br />UMBRELLA LJAB
<br />OCCUR
<br />EACH OCCURRENCE
<br />0,000,000
<br />R
<br />EXCESS LIAS:
<br />CLAIMS-MADE
<br />6014253989
<br />10101/2014
<br />10101/20I5
<br />AGGREGATE
<br />6,00000 0
<br />bLO I X I RETENTION.$ 0
<br />$
<br />A
<br />WORKERS COMPENSAMON
<br />AND EMPLQYERS'LIABLITY
<br />ANY P'ROPRIETORIPARTNE I R/EXECUT IVE YIN
<br />OFFICER /MEMBER EXCLUDED?
<br />"Mandatory In NH)
<br />If y05, dos6rbe t radar
<br />DESCRIPTION OF OPERATIONS bblov4
<br />NIA
<br />5094617861
<br />110/101/2014,
<br />10/0112015
<br />X PER 01H
<br />ER
<br />E ,L. EACI-jACCIDENT
<br />$ 1 1,10 . 00,060
<br />E.L. DISEASE - EA EMPLOYEE
<br />. ..... ...... ..
<br />$ 1;000,00 C
<br />E;.L- DISEASE'- POLICY -LIMB'
<br />$
<br />Q.
<br />Prof Li.ab/Clrrrs Made
<br />RSE42315461514,
<br />101,01 /2014
<br />10101/2015
<br />Per Cla im 2,000,000
<br />C
<br />Ded.'$25k Per Claim
<br />RSE42315461514
<br />10/01,/20 . 14
<br />10/01/2015
<br />Aggregate 2,000,00 o
<br />)EscRiPTION OF OPERATONs'l LOCATIONS I VEHICLES (ACORD 161, AddItIonal Remarks Schedule, may be attached I If more spacq Is requIred)
<br />Re: All Operations:
<br />City of Santa Ana, its offerers, employees, agents, volunteers and rePresentativs, are Additional Insured's with respect to General Liability per the attached
<br />endorsement as,required by written. contract. Insurance Is Pri-mary.and N,on-Contributory.
<br />30 Days Notice of -Cancellation With 10 Days Notice for Non-Payment of Premium in accordance with the policy provisions.
<br />CERTIFICATE HOLDER CANCELLATION
<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 AUTHDRIZED REPRESENTATIVE
<br />20 Civic Center Plaza (M-21)
<br />P.O. Box 1988
<br />ISanta Ana, CA 92702-
<br />1988-201,4 ACQRD CORPORATION. All rights.reserved,
<br />ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD
<br />
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