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AC"RCI°
<br />,. CERTIFICATE OF LIABILITY INSURANCE
<br />DATE (MM/DD/YYYY)
<br />7/6/2016
<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 />NAME: Marie Swane
<br />PHo"E 626 844 3070 FAX
<br />AC Noj —
<br />E-MAIL mSWaneYdeale renton.comD.
<br />INSURERS AFFORDING COVERAGE NAIC If
<br />License #0020739
<br />INSURERA:Travelers Indemnity Co. of Connecti 25682
<br />7/20/2016 7/20/2017
<br />INSURED CIVILSOUR
<br />INSURERB;Trayelers Property Casualty Co of A '25674
<br />CivilSource, Inc.
<br />INSURERC:Trumbull Insurance Company 27120
<br />9890 Irvine Center Drive
<br />Irvine, CA 92618
<br />suRERD;Travelers Casualty &Surety Co. Ame
<br />INSURER
<br />131194
<br />INSURER E:
<br />_
<br />DAMAGES (RENTED
<br />PREMISES (Ea occurrence)
<br />949 585-0477
<br />INSURER F:
<br />X Contractual Liab —__
<br />COVERAGES CERTIFICATE NUMBER: 1137089151 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 />ILTR
<br />TYPE OF INSURANCE
<br />I D
<br />WVD>
<br />------
<br />POLICY NUMBER
<br />POLICY EFF POLICY EXP
<br />MM/DD/YYYY MM/DD/YYYY
<br />----- - ------
<br />LIMITS
<br />B
<br />X COMMERCIAL GENERAL LIABILITY
<br />Y
<br />Y
<br />68028101-758
<br />7/20/2016 7/20/2017
<br />EACH OCCURRENCE
<br />$2,000,000
<br />CLAIMS -MADE " OCCUR
<br />_
<br />DAMAGES (RENTED
<br />PREMISES (Ea occurrence)
<br />$1,000,00_0__
<br />X Contractual Liab —__
<br />_
<br />MED EXP (Any one person)
<br />$10,000
<br />X .. XCU Included
<br />PERSONAL & ADV INJURY
<br />$2,000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />[GENERAL_ AGGREGATE
<br />$4,000,000RO
<br />POLICY 7X jECT LOC
<br />PRODUCTS - COMP/OP AGG
<br />$4,000,000_____
<br />$
<br />OTHER:
<br />A
<br />AUTOMOBILE LIABILITY
<br />Y
<br />Y
<br />BA45921_377
<br />7/20/2016
<br />7/20/2017
<br />COMBIgaaccNED
<br />_ SINGLE LIMIT
<br />-------
<br />$1,000,000
<br />- - — ... — -
<br />ANY AUTO
<br />BODILY INJURY (Per person)
<br />$
<br />ALL OWNED SCHEDULED
<br />AUTOS AUTOS
<br />NON -OWNED
<br />X HIRED AUTOS X AUTOS
<br />BODILY INJURY (Per accident)
<br />$
<br />PROPERTY DAMAGE _
<br />Per accident
<br />-
<br />$
<br />X NoOwnedAutos
<br />B
<br />X UMBRELLA LIAB
<br />X OCCUR
<br />Y
<br />Y
<br />CUP6772Y251
<br />7/20/2016
<br />7/20/2017
<br />EACH OCCURRENCE
<br />AGGREGATE
<br />_$1,000,000
<br />$1,000,000
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />'.... DED '.... X RETENTION $ 0
<br />$
<br />C
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY Y / N
<br />ANY PROPRIETOR/PARTNER/EXECUTIVE❑
<br />OFFICER/MEMBER EXCLUDED?
<br />N / A
<br />Y
<br />72WEGZQ4447
<br />7/20/2016
<br />7/20/2017
<br />XPER
<br />STATUTE J ER OTH-
<br />E.L. EACH ACCIDENT
<br />_
<br />$1,000,000
<br />_ -------- ----
<br />E.L. DISEASE - EA EMPLOYE
<br />...... .._-.-__
<br />$1,000,000____
<br />Mandato m NH
<br />(ry )
<br />I
<br />If yes, describe under
<br />------- -----
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE - POLICY LIMIT
<br />1 $1,000,000
<br />D
<br />Professional Liability
<br />105968526
<br />7/20/2016
<br />7/20/2017
<br />$2,000,000 Per Claim
<br />Claims Made Form
<br />I
<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 operations of thenamed insured as required per
<br />written contract or agreement. Insurance includes primary and non-contributory wording per the attache endorsement(s). Insurance
<br />coverage includes waiver of subrogation per the attached endorsement(s) ----
<br />RE V@I 1N p' & lul l4(c k; l r Pai/� (r -
<br />�.. ___... _ .. f,r _..: __ w ..... _ ..... ._. ..- _._._ . __.
<br />.CRI Irl%,IAI C rIVLUCR %,/A 4L MLLHIIVIV JV VCIY IVVV/ IV IJOY IVI IVUHr'CIV UI r-ICI11
<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 />O 1988-2014 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD
<br />
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