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PENCENG-01 FRANCISC
<br />AGORA CERTIFICATE OF LIABILITY INSURANCE �DATE(�MM/DD/YYYY)
<br />7/21/2017
<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 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 of such endorsement(s).
<br />PRODUCER License # OE67768 CONTACT Marie Benjamin
<br />NAME:
<br />IDA Insurance Services PHONE FAX
<br />3875 Hopyard Road (A/c, No, Ext): (925) 660-3530 50030 (A/c, No): (925) 416-7869
<br />Suite 240 noDRIL Marie. Benjamin@ioausa.com
<br />Pleasanton, CA 94588
<br />. __ INSURER(S) AFFORDING. COVERAGE '.. NAIC #
<br />INSURER A:RLlInsurance _Company 13056
<br />INSURED INSURER B;.Atlantic Specialty Insurance Company 27154.""„
<br />Penco Engineering, Inc.
<br />16842 Von Karman Avenue, Suite #150
<br />Irvine, CA 92606
<br />INSURER D :
<br />INSURER E :
<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 CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH
<br />THIS
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES
<br />DESCRIBED HEREIN IS SUBJECT TO ALL THE
<br />TERMS,
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY
<br />PAID CLAIMS.
<br />INSR':" TYPE OF INSURANCE 'ADDLSUBR POLICY NUMBER POLICY EFF
<br />TR N D WV M DD YY
<br />POLICY EXP LIMITS
<br />MM D Y
<br />A X COMMERCIAL GENERAL LIABILITY
<br />EACH OCCURRENCE $
<br />1,000,000
<br />CLAIMS -MADE X ' OCCUR PSB0006402 07/21/2017 '
<br />07/21/2018 DAMAGE TO RENTED
<br />PREMISES (Ea occurrence)._. $
<br />1,000,000
<br />MED" EXP (Any one person).... $
<br />10,000
<br />PERSONAL & ADV INJURY $
<br />1,000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />GENERAL AGGREGATE $
<br />2,000,000
<br />POLICY X PPp LOC
<br />PRODUCTS - COMP/OP AGO $
<br />2,000,000
<br />OTHER:
<br />$
<br />A AUTOMOBILE LIABILITY
<br />COMBINED SINGLE LIMIT
<br />(Ea accident) $
<br />1,000,000
<br />X ANY AUTO PSA0002222 07/21/2017
<br />07/21/2018 BODILY INJURY (Per person) $
<br />OWNED SCHEDULED
<br />._ AUTOS ONLY AUTOS
<br />BODILY INJURY (Per accident) $
<br />OS ONLY NON-OWNED
<br />X ! AT XSONL
<br />ONLY
<br />POaednt}AMAGE
<br />(r c$
<br />$
<br />A UMBRELLA LIAB" X OCCUR
<br />EACH OCCURRENCE $
<br />1,000,000
<br />X EXCESS LIAB CLAIMS -MADE PSE0002785 07/21/2017',
<br />07/21/2018 AGGREGATE $
<br />_....
<br />1,000,000
<br />j DED X RETENTION $
<br />$
<br />_.. .._.
<br />A WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY
<br />X PER OTH-
<br />STATUTE ', ER__..
<br />YIN PSW0003626 07/21/2017
<br />PROPRIETOR/PARTNER/EXECUTIVE
<br />07/21/2018
<br />E.L. EACH ACCIDENT $
<br />1,000,000
<br />OFFICERWEMBER EXCN / A
<br />in NH) '..
<br />1,000,000
<br />(Mandatory
<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 ',Professional Liab. DPL700617 07/21/2017',
<br />07/21/2018 Per Claim
<br />2,000,000
<br />B IDed Per Claim $25k DPL700617 07121/2017',
<br />07/21/2018 Aggregate
<br />3,000,000
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more
<br />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
<br />as respects to General Liability as required
<br />by written
<br />contract. Primary and Non -Contributing coverage applies to GL as required by written contract. Waiver
<br />of Subrogation or Rights applies to Workers
<br />Compensation policy only as required by a written signed contract prior to any loss occurring.
<br />REVIEWED FSY:
<br />EUNIC:E HEREDIA (PG ( OF
<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 />AUTHORIZED PRESENTATIVE
<br />City of Santa Ana
<br />20 Civic Center Plaza -Ross Annex M-36
<br />ACORD 25 (2016/03) OO 1988-2015 ACORD CORPORATION. All rights reserved.
<br />The ACORD name and logo are registered marks of ACORD
<br />
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