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®CIVIL SOURCE AGR #TBD REVIEWED BY 41, FI IwcF LIFRFn!n rPn '1 np� Ri
<br />� -
<br />ACCORD
<br />'�li,.,q�—/�p', CFI .TIFICATE OF LIABILITY INSURANCE
<br />DATE (MMIDD/WYY)
<br />7/17/2015
<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(les) 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 doss not confer rights to the
<br />certificate holder in lieu of such endorsements).
<br />PRODUCER
<br />Dealey, Renton & Associates
<br />P. O. Box 10550
<br />Santa Ana, CA 92711-0550
<br />NOMEACT Sandy Peters
<br />PpoNE 626 844-3070 FAX 626 844-3074
<br />AICMlExn:_-. . ek
<br />R -MAIL s eters@deals renton.COm
<br />.AOoeEss' p Y _
<br />INSURER(S)APFORDINGCOVERAGE_
<br />NAICN
<br />License#0020739
<br />INSURERA:Trayelers indemnity Co. of Connects
<br />25682 _
<br />$2,000,000
<br />INSURED CIVILSOUR
<br />INSURER B:Travelers Prosy Casualty CO of —A.---.—
<br />'31194
<br />25674
<br />INSURER c:TravelersCasualty&SureiyCoofAme
<br />XJ xGUlncluded
<br />CivilSouroe,Inc,
<br />9890 Irvine Center Drive
<br />Irvine, CA 92618
<br />INSURER D:
<br />GENERALAGGREGATE
<br />$4,000,000
<br />PRODUCTS-COMPIOPAGG
<br />949585.0477
<br />ENSURER E:
<br />$
<br />INSURER F;
<br />AUTOh7081LE LIAe1LiTY
<br />ANY AUTO
<br />ALL 0WN00 SCHEDULED
<br />X HIREDAUTOSX NON -OWNED
<br />— AUTOS
<br />Y
<br />cl'1vpRAraFR CERTIFICATE NUMBER: 1973460479 REVISION NUMBER:
<br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR TI1E 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 />MLTA SR
<br />TYPEOrINSURANCE
<br />INSR
<br />WVDI
<br />POLICY NUMBER
<br />MMIDIDIYYYY
<br />MMIDDIYYYY
<br />LIMITS
<br />A
<br />X I COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MAGE 50 OCCUR
<br />Contracioal Llab
<br />Y
<br />Y
<br />60028101.758
<br />7120/2015
<br />7120/2016
<br />EACH OCCURRENCE
<br />$2,000,000
<br />PREAI� R oraurenoaI
<br />$1,000000
<br />MET EXP (Any me person)
<br />910,000
<br />XJ xGUlncluded
<br />PERSONAL &ADV INJURY
<br />12,000,000
<br />GEN'L AGGREGATE LIMII'APPLIES PER:
<br />POLICY ®PEC LOC
<br />OTHER:
<br />GENERALAGGREGATE
<br />$4,000,000
<br />PRODUCTS-COMPIOPAGG
<br />$400D.000
<br />$
<br />6
<br />AUTOh7081LE LIAe1LiTY
<br />ANY AUTO
<br />ALL 0WN00 SCHEDULED
<br />X HIREDAUTOSX NON -OWNED
<br />— AUTOS
<br />Y
<br />IBA4592L377
<br />712012015
<br />7120/2010 A
<br />NN
<br />EaNeccltlent Ell
<br />$1,000,000 _
<br />BODILY INJURY(Perperson)
<br />$
<br />BODILY INJUAlfl"QRY Peraccidenq
<br />$
<br />PROPERTY DAMAGE
<br />Por aCGldenO
<br />T
<br />______
<br />$
<br />B
<br />X
<br />UMBRELLALIAB
<br />EXCESS LIAB
<br />X
<br />OCCUR
<br />CLAIMS -MADE
<br />Y
<br />Y
<br />CUP6772Y25'I
<br />1
<br />'712012015
<br />7120/2016
<br />EACH OCCURRENCE
<br />$1,000,000
<br />_
<br />AGGREGATE .�
<br />_
<br />$1,006,000
<br />_
<br />bED X I RETENTIONGO
<br />$�
<br />g
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY IN
<br />ANY PROPRIETORIPARTNERreXECUTIVE Y"—I
<br />OFFICER/MEMBER EXCLUDED! LJ
<br />(Mandatory In Ism
<br />! DYyes describo under
<br />TE6dRIPTION OF OPERAilON6 Will
<br />NIA
<br />Y
<br />�U85711Y618
<br />712012015
<br />7120/2018X
<br />SAT TET OgQ�,_
<br />E.L. EACH ACCIDENT
<br />x$1,000,000
<br />B.L. DISEASE- EA EMPLOYEE$11000,000
<br />R.L. DISEASE POLICY LIMIT
<br />_
<br />$1.000,000
<br />C
<br />Professional Liability
<br />Claims Made
<br />105980520
<br />'7[2912015
<br />7/20/2016
<br />$2,000,000 Per Claim
<br />$2,000,000 Annual Aggregate
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES IACORD 101, Additional Romania SchoduM, may be e0achod If mora space Is required)
<br />*General Liability poiley excludes Claims arising out of the performance of professional services.*
<br />**Umbrella policy Is a follow -form to underlying General Liability/Hired&Non-Owned Auto Liability/Employers Liability.**
<br />Re: City Engineering Services -- City of Santa Ana and their officers, agents and employees are named as additional insured as respects
<br />general and hired/non-owned auto liability for claims arising from the operations of the named insured as required per written contract.
<br />Insurance includes primary and non-contilbulory wording per the attached endorsement(s). Insurance coverage includes waiver of
<br />subrogation per the attached andorsement(s).
<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 />©1988.2014 ACORD CORPORATION. All
<br />ACORD 25 (2014101) 'The ACORD name and logo are registered marks of ACORD
<br />
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