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Client #: 835015
<br />ALTAPLAN
<br />ACORD,. CERTIFICATE OF LIABILITY INSURANCE
<br />DATE(MM /DD /YYYY)
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
<br />8/11/2016
<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 />NAMEACT Karen Barry
<br />US[ Northwest
<br />PHONE FAX
<br />%, Ext : 503 224 -8390 A/c, No ; 610 362 -8130
<br />700 NE Multnomah, Suite 1300
<br />E-MAIL
<br />karen.barry @usi.biz
<br />Portland, OR 97232
<br />ADDRESS:
<br />503 224 -8390
<br />INSURER(S) AFFORDING COVERAGE NAIC #
<br />INSURER A: Charter Oak Fire Insurance Comp 25615
<br />_
<br />INSURED
<br />INSURER B: Travelers Property Casualty Ins 36161
<br />Alta Planning + Design, Inc.
<br />_ -- —
<br />INSURER c: Travelers Indemnity Company 25658
<br />711 SE Grand Avenue
<br />INSURER D: SAIF Corporation 36196
<br />Portland, OR 97214
<br />INSURER E: Zurich American Ins. Co.
<br />120443
<br />INSURER F: Continental Casualty Company
<br />$2,000,000
<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 CONTRACTOR 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 />ADDL
<br />INSR
<br />SUBR
<br />WVD
<br />POLICY NUMBER
<br />POLICY EFF
<br />MM /DD /YYYY
<br />POLICY EXP
<br />MM /DD /YYYY
<br />LIMITS
<br />A
<br />B
<br />XCOMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE X OCCUR
<br />68088259484
<br />68086259331
<br />7/01/2016
<br />07/01/2016
<br />07/01/2017
<br />07/01/2017
<br />EACH OCCURRENCE
<br />$2000000
<br />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 />$2,000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />POLICY I AI JECOT 1-1 LOC
<br />GENERAL AGGREGATE
<br />$4,000,000
<br />PRODUCTS - COMP /OP AGG
<br />$4,000,000
<br />C
<br />AUTOMOBILE LIABILITY
<br />BA7A574417
<br />7/01/2016
<br />07/01/201
<br />COMINED
<br />(Ea accdentSINGLELIMIT )
<br />1,000,000
<br />BODILY INJURY (Per person)
<br />$
<br />X ANY AUTO
<br />ALL OWNED SCHEDULED
<br />AUTOS AUTOS
<br />_ .
<br />X',. HIRED AUTOS .. X NON -OWNED
<br />AUTOS
<br />BODILY INJURY (Per accident)
<br />$
<br />PROPERTY DAMAGE
<br />Per accident
<br />$
<br />$
<br />C.
<br />X'.. UMBRELLA LIAB X OCCUR
<br />CUP8B259933
<br />7/01/2016
<br />07/01/2017
<br />ACHOCCURRENCE
<br />$5000000
<br />EXCESS LIAR CLAIMS -MADE
<br />AGGREGATE
<br />s5,000,000
<br />I X '', RETENTION $10000
<br />$
<br />D
<br />E
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY
<br />ANY PROPRIETOR /PARTNER /EXECUTIVE Y / N
<br />OFFICER /MEMBER EXCLUDED? �
<br />(Mandatory in NH)
<br />N / A
<br />771940
<br />8997892
<br />WA Stop Gap -EL
<br />9/01/2016
<br />9/01/2016
<br />09/01/2017
<br />09/01/2017
<br />X IsPTEATLITE OTH-
<br />FA
<br />E.L. EACH ACCIDENT
<br />$1 0,00,000
<br />E.L. DISEASE - EA EMPLOYEE
<br />$1,000,000
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />OH Stop Gap -EL
<br />E.L. DISEASE - POLICY LIMIT
<br />-
<br />$1,000,000
<br />F
<br />Professional
<br />MCH114135257
<br />7/01/2016
<br />07/01/2017
<br />$4,000,000 Per Claim
<br />Liability
<br />$4,000,000 Aggregate
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
<br />RE: Bicycle Safety Consultant Agreement. The City of Santa Ana, its officers, employees, agents, volunteers
<br />and representatives are included as Additional Insureds for General Liability and Auto Liability pursuant
<br />to written contract or agreement as provided by attached endorsements CGD3810907 and CAT4200215. Coverage
<br />applies on a primary and non contributory basis and is primary to other insurance that is available to the
<br />Additional Insured as required by written contractor agreement. Should described_pollcies s ncelled
<br />_,._.
<br />(See Attached Descriptions) L" EV- Erb VED BYE 1:=lIk� CEO HEM.-_` (PG % O "d
<br />7C,
<br />The City of Santa Ana
<br />20 Civic Center Plaza - Ross
<br />Annex
<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 />4 ACORD CORPORATION. All rinhtc rpearvarl
<br />ACORD 25 (2014/01) 1 of 2 The ACORD name and logo are registered marks of ACORD
<br />#S18411397/M18398606 RDSZP
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