|
Client#: 835015
<br />ALTAPLAN
<br />ACORD.- CERTIFICATE OF LIABILITY INSURANCE
<br />Dar
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
<br />t221'2arcYYY)
<br />12!22/2015
<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 poliay(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 ry ME: Karen Barry
<br />USI Northwest HONE 503224. 8390 610 362 - 81300_
<br />_LA, NO E, t).
<br />___�
<br />700 HE Multnomah, Suite 1300 i ADDRESS: karen.barry@usi,biZ
<br />Portland, OR 97232
<br />INSURERIS) AFFORDING COVERAGE NAIC 0
<br />503 224 - 8390
<br />INSURER A, Charter Oak Fire Insurance Co. 25615
<br />INSURED INSURERS: Travelers Property Casualty Ins
<br />36161
<br />Alta Planning + Design, Inc. INSURER D: Travelers indemnity Company
<br />25658
<br />Grand Avenue INSURER Corporation
<br />INSURER O:
<br />36196
<br />Po la
<br />Portland, OR 97214
<br />INSURER E: Zurich American Ins. Co.
<br />16535
<br />w3URER P: Continental Casualty Company
<br />20443
<br />COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
<br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMES 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 />SR .App[ SUBgPOITCYE P01 yx _t_
<br />LTR TYPE OK INSURANCE IINS�D, POLICY NUMBER MMIDOIYYYY MMIDOIY Y LIMITS
<br />A
<br />GENERALLIABIWTY
<br />168OBB259484
<br />07/0112015
<br />07!011201
<br />EACHOCCURRENCE
<br />$2,000,000
<br />8
<br />X COMMERCIAL GENERAL LIABILITY
<br />166088259331
<br />07101/201$
<br />07101/201E
<br />1,000,000
<br />MED EXP Any dnP Person)
<br />810,000 ___
<br />GUUMS�MADE ®OCCUR
<br />I
<br />.)
<br />PERSONAL &ADV INJURY
<br />$2000,000`
<br />GENERAL AGGREGATE
<br />84,000,000
<br />GEN'L AGGREGATE LE�11ITAPf APPLE. PER
<br />iPRODUCTS- COMP /bP AGO
<br />�QQ
<br />POLICY X PRAT I—I LOC
<br />—r
<br />�$4,OQQ
<br />$
<br />[j
<br />AUTOMOBILE
<br />LIABILITY
<br />I BA7A574417
<br />67101 12015
<br />Q7iQ 11201 �IE3
<br />COUBIN ED SINGTE LIMIT
<br />app dehtt
<br />1, QQQ QQQ
<br />X
<br />ANYAUTD
<br />i BODILY INJURY (Per person)�
<br />$
<br />ALLOWNEO SCHEDULED
<br />AUTOS AUTOS
<br />BODILY INJURY (Per 3orident)
<br />$
<br />X
<br />NOM OVVNEO
<br />hIIREO AUTOS X AUTOS
<br />!
<br />PROPCRTY DAMAGE
<br />LLP3 ycc de U __
<br />S� TM
<br />C
<br />)(
<br />UMBRELLA LIAR X GpDOR
<br />CUP68259933
<br />Q7/Q1/2Q151071Q1l2Q1
<br />EACHOCCURRENCE
<br />SQQQjQQQ
<br />EXCESS LIA6 _.CLAIMS NInOEf
<br />(_AGGREGATE _
<br />85�QOQ,QQQ�.
<br />DED I X RETENTION31Q 000
<br />D
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS UABLITY
<br />1
<br />j77194Q —
<br />09/01/2015
<br />09!011201
<br />X TWC- STATU. ,OT }b
<br />YIN'
<br />I
<br />16997692
<br />E
<br />ANY PROPRCTOR(PARTNERGXECUTIVE
<br />prfIGER'MEMBER EXCLUDED? [Y]INiA
<br />09 101 12015
<br />Q97Q1f2Q1 "1—
<br />El, EACH ACCIDENT
<br />- --
<br />31 000,000
<br />.Y - -..
<br />(Mandrn.q In NH)
<br />( WA Stop Gap -EL
<br />Included
<br />B�DIScASE EA EMPLOYEE
<br />$1,000,000
<br />I( yes, denafiba node,
<br />DESCRIPTIONOF OPERAnONS b §Inw _
<br />OH Stop Gap -EL —
<br />Included
<br />IEl-
<br />DISEASE - POLICY LIMIT
<br />$1,000,000
<br />F
<br />Professional {
<br />I� MCH114135257
<br />07/0112015
<br />0710112010
<br />$3,000,000 Per Claim
<br />Liability
<br />I
<br />$4,000,000 Aggregate
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if morn space is required)
<br />RE: City of Santa Ana, its officers, employees, agents, volunteers and representatives are Additional
<br />Insureds for General Liability when required by written contract or agreement as to extent provided by
<br />attached endorsement CGD3810907, Coverage applies on a primary and noncontributory basis as required by
<br />written contract or agreement. Should described policies be cancelled before the expiration date thereof,
<br />the Issuing company will mail 30 days advance written not' e_Lq_tbg c i i or ed xcrn�y#, fOP
<br />nonpayment and Workers Compensation. REVIEW_9BY: , EUN43EHEREOi,$(P(3 , OF )
<br />City of Santa Ana
<br />201 Civic Center Plaza (M -30)
<br />P.O. Box 1988
<br />Santa Ana, CA 92702.1988
<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 REPRESENTATNE
<br />J 1988.2010 ACORD CORPORATION. All rights reservad
<br />ACORD 25 (2010105) 1 of 1 The ACORD name and logo are registered marks of ACORD
<br />#$169113881M16B54436 SUPZP
<br />
|