|
AC C>RLa�
<br />-.. CERTIFICATE OF LIABILITY INSURANCE
<br />DATE (MM/DD/YYYY)
<br />12/13/2016
<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 endorsements .
<br />PRODUCER
<br />Cavignac & Associates
<br />450 B Street, Suite 1800
<br />San Diego CA 92101
<br />CONTACT
<br />NAME: Certificate Department
<br />PH°NE 619-744 0574 FAX 619-234-8601
<br />AC No:
<br />_ADDR .IL certificates@cavignac.com
<br />INSURERS AFFORDING COVERAGE NAIC #
<br />Y
<br />INSURERA:Travelers Indemnity Co of Conn ,25682
<br />6801H979452
<br />INSURED KTU&APL-01
<br />INSURER B: Travelers Property & Casualty Coma ',25674
<br />KTU+A Planning & Landscape Architecture
<br />INSURER C: Hartford Accident & Indemnity
<br />3916 Normal Street
<br />San Diego CA 92103
<br />INsuRERD:Berkley Insurance Company
<br />INSURER E:
<br />INSURER F :
<br />DAMAGE TO RENTED
<br />PREMISES Ea occurrence $1,000,000
<br />COVERAGES CERTIFICATE NUMBER: 888965120 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 />INSR
<br />LTR
<br />TYPE OF INSURANCE
<br />IIIADIDE
<br />INSD
<br />RT_____
<br />WVD
<br />POLICY NUMBER
<br />POLICY EFF
<br />MM/DD/YYYY
<br />POLICY EXP
<br />MMIDDIYYYY
<br />LIMITS
<br />A
<br />X COMMERCIAL GENERAL LIABILITY
<br />Y
<br />6801H979452
<br />9/1/2016
<br />9/1/2017
<br />EACH OCCURRENCE $1,000,000
<br />CLAIMS -MADE X❑ OCCUR
<br />DAMAGE TO RENTED
<br />PREMISES Ea occurrence $1,000,000
<br />X Contract. Liab.
<br />MED EXP (Any one person) ( $10,000
<br />X Sep. Of Insureds
<br />PERSONAL & ADV INJURY $1,000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />GENERAL AGGREGATE $2,000,000
<br />X POLICY F_x1 PE EI LOC
<br />PRODUCTS - COMP/OP AGG $2,000,000
<br />_
<br />$
<br />OTHER:
<br />B
<br />AUTOMOBILE LIABILITY
<br />BA1C934192
<br />9/1/2016
<br />9/1/2017
<br />CO BINED SINGLE accident)__ LIMIT
<br />I $1,000,000
<br />BODILY INJURY (Per person) $
<br />ANY AUTO
<br />''. AUTOWNED SCHEDULED
<br />AUTOS
<br />X HIRED AUTOS X NON -OWNED
<br />AUTOS
<br />BODILY INJURY (Per accident) $
<br />PROPERTY DAMAGE
<br />Per accident
<br />Bi
<br />UMBRELLA LAB
<br />X
<br />OCCUR
<br />CUPIC934653
<br />9/1/2016
<br />9/1/2017
<br />EACH OCCURRENCE $3,000,000
<br />X i EXCESS LAB
<br />CLAIMS -MADE
<br />AGGREGATE $3,000,000
<br />DED '.. X RETENTION $0
<br />$
<br />C
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY Y / N
<br />72WEGGG6436
<br />9/1/2016
<br />9/1/2017PER
<br />OTH-
<br />X STATUTE L ER
<br />ANY PROPRIETOR/PARTNER/EXECUTIVE ❑
<br />OFFICER/MEMBER EXCLUDED?
<br />N /A
<br />E.L. EACH ACCIDENT $1,000,000
<br />--
<br />E.L. DISEASE - EA EMPLOYE $1,000 000
<br />(Mandatory in NH)
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE - POLICY LIMIT $1,000,000
<br />D
<br />Professional Liability
<br />AEC901111601
<br />9/1/2016
<br />9/1/2017
<br />Each Claim $2,000,000
<br />Aggregate $4,000,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
<br />Additional Insured coverage applies to General Liability for City of Santa Ana, its officers, agents,
<br />and employees per policy form. Prof. Liab. - Claims matte, defense costs included within limit. If the
<br />insurance company elects to cancel or non -renew coverage for any reason other than nonpayment of premium
<br />Cavignac & Associates will provide 30days notice of such cancellation or nonrenewal.
<br />REVIF WED BY Ft.)NiC F d iEF{FDiA (PG OF )
<br />CERTIFICATE HOLDER CANCELLATION
<br />@ 1988-2014 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />City of Santa Ana
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />Attn: Purchasing Department
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />20 Civic Center Plaza
<br />Santa Ana CA 92701
<br />AUTHORIZED REPRESENTATIVE
<br />@ 1988-2014 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD
<br />
|