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PENCENG-01 GORDONS
<br />CERTIFICATE OF LIABILITY INSURANCE
<br />DATE 1
<br />7115/215/2016
<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 License 4 OE67768
<br />CONTACT
<br />NAME: Victoria Godfrey
<br />IOA Insurance Services
<br />3875 Hopyard Road
<br />PHONE 925 416-7862 FAX 925 416-7869
<br />A/c No Ext : ( ) {A/C, No): ( )
<br />EMAIL
<br />ADDRESS:
<br />Suite 240
<br />Pleasanton, CA 94588
<br />INSURER(S) AFFORDING COVERAGE
<br />NAIL #
<br />INSURE A: RLI Insurance Company
<br />13056
<br />INSURED
<br />INSURER B: Atlantic Specialty Insurance Company
<br />27154
<br />INSURERC;
<br />Penco Engineering, Inc.
<br />INSURER D
<br />16842 Van Karman Avenue, Suite #150
<br />Irvine, CA 92606
<br />-- - -
<br />INSURER E .
<br />INSURER F :
<br />CUVtHAUL3 CERTIFICATE NIJMRFR- Qr=vletnnt nn tneacD.
<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 />._
<br />TYPE OF INSURANCE
<br />rADDL!SUBR
<br />IINSD'WVD
<br />POLICY NUMBER
<br />MM/DD/YYYY
<br />MM/DD/YYYY
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE �X.� OCCUR
<br />-
<br />I
<br />IPSB0006402
<br />07/21/2016
<br />07/21/2017
<br />EACH OCCURRENCES
<br />PREMiSEs_(EaoccLrronce)__
<br />1,000,000
<br />—
<br />s 1,000,000
<br />..1,00 --
<br />...
<br />MEDEXP-(Any one, person)
<br />S 10,000
<br />PERSONAL R ADV INJURY
<br />S 1,000,000
<br />AGGREGATE LIMIT APPLIES PER:
<br />PRO-
<br />POLICYa JECTEl
<br />GEN'LL
<br />GENERAL AGGREGATE
<br />S 2,000,000
<br />PRODUCTS-COMP/OPAGG
<br />—..
<br />_ ._.. -
<br />a 2,000,000
<br />_ .
<br />S
<br />OTHER:
<br />A
<br />AUTOMOBILE
<br />XANYAUTO
<br />X
<br />LIABILITY
<br />ALL OWNED SCHEDULED
<br />AUTOS --- AUTOS
<br />NON -OWNED
<br />HIRED AUTOS X AUTOS
<br />j
<br />PSA0002222
<br />07/21/2016
<br />I
<br />07121/20171
<br />COMBINED SINGLE LIMIT
<br />Ea acadenti
<br />S 1,000,000
<br />BODILYINJURY(Perperson)
<br />-- ---
<br />I BODILY INJURY (Per accident)
<br />PROPERTY DAbtAGE
<br />-(Peraccldent)
<br />S
<br />S
<br />_.--._--------....._....
<br />$
<br />$
<br />A
<br />UMBRELLA LIAB
<br />EXCESS LIAB
<br />X
<br />OCCUR
<br />CLAIMS -MADE
<br />PSE0002785
<br />07/21/2016
<br />07/21/2017
<br />EACH OCCURRENCE
<br />8 1,000,000
<br />AGGREGATE
<br />S 1,000,000
<br />DED I X RETENTION $
<br />S
<br />A
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY YIN N
<br />ANY PROPRIETOR/PARTNER/EXECUTIVE
<br />OFFICER/MEMBER EXCLUDED?
<br />N / A
<br />PSW0003626 07/21/2016
<br />..
<br />07/21/2017
<br />X PER OThI
<br />S I'ATUTE _ ER
<br />EL EACH ACCIDENT
<br />$ 1,000,000
<br />E.L. DISEASE -EA EMPLOYEE
<br />$ 1,000,000
<br />(Mandatory in NH)
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />1
<br />E.L. DISEASE -POLICY LIMIT
<br />$ 1,000,000
<br />B
<br />Professional Liab.
<br />DPL-6661-16 07/21/2016
<br />07/21/2017
<br />Per Claim 2,000,000
<br />B
<br />Ded Per Claim $25k
<br />DPL-5661-16 07/21/2016
<br />I
<br />07/21/2017
<br />Aggregate 3,000,000
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required)
<br />Re: On Call Engineering Services. Agreement numbers A-2008-218 and A-2015-236.
<br />City of Santa Ana, Its officers, employees, agents, volunteers and representatives are additional insured as respects to General Liability as required by written
<br />contract. Primary and Non -Contributing coverage applies to GL as required by written contract. Waiver of Subrogation or Rights applies to Workers
<br />Compensation policy only as required by a written signed contract prior to any loss occurring. r
<br />( REVIEWED D B / � � r E t IA kBC, i f 1P- EKED (PG +, y l
<br />City of Santa Ana
<br />20 Civic Center Plaza -Ross Annex (M-36)
<br />IYIrCL _A 11UN
<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 />V IUUS-ZU14 ACORD CORPORATION. All rights reserved.
<br />ACORD 26 (2014101) The ACORD name and logo are registered marks of ACORD
<br />
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