|
ACC>R" CERTIFICATE OF LIABILITY INSURANCE r
<br />ATE(MMIDDIYYYY)
<br />8/29/2019
<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 have ADDITIONAL INSURED provisions or be endorsed.
<br />If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on
<br />this certiflcato does not confer rights to the certificate holder in lieu of such endorsement(s).
<br />PRODUCER CONTACT
<br />Woodruff -Sawyer & Co. prAONe Katharine Tiller I A--
<br />2 Park Plaza, #500 W—Cc Ne,Elll;_ga9.a35.7353 AiC.No:949.476.3118
<br />Irvine CA 92614 E-MAIL
<br />AonRE$S• klillerawsandcq.com
<br />irvaur<tu
<br />Iteris, Inc.
<br />1700 Carnegie Avenue, Suite 100
<br />Santa Ana CA 92705-5551
<br />INSURER(S) AFFORDING COVERAGE
<br />INSURER A: Valley Forge Insurance Company
<br />IrERINC-01 twiuRERa:Continental Insurance_ Company
<br />INS1H2ER. c - COIUmbia Casualty Company
<br />INSURER O
<br />INSURER E-
<br />INSURER F :
<br />COVERAGES CFRTIFICATP KHIMRFR•A1An7A1rA Dr=A11421rNK1 unisnDOD.
<br />NAIC p
<br />20508
<br />35289
<br />31127
<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 />IN5R A PO[aCY EFF POLICY Exp
<br />•. TR " TYPE OF INSURANCE POL1C NUMBER MMIDDfYYYY MMIDWAY-Y LIMITS
<br />A X COMMERCIAL GENERAL LIABILITY
<br />Y
<br />6057362701
<br />4/1/2019
<br />4/1/2020 EACH OCCURRENCE
<br />$2,000,000
<br />77 I
<br />r6 R€NTH
<br />CLAIMS -MADE r OCCUR
<br />PREMISEIS S (Ea oncurrence
<br />$2,000,000
<br />MED EXP )Any one pamah)
<br />S 15,000
<br />X BI Ded. None _
<br />PERSONAL & ADV INJURY
<br />$ 2,000,000
<br />GEN'LAGGREGATE LIMIT APPLIES PER:
<br />GENERAL AGGREGATE
<br />$4,000,000
<br />L_I X_.i
<br />POLICY JECT LOC
<br />1
<br />PRODUCTS - COMP/OPAGG
<br />$4,000,000
<br />X OTHER:
<br />$
<br />A AUTOMOBILE
<br />LIABILITY
<br />6057362682 4/1/2019 4/1/2020
<br />COMBINI:DSINGLELIMIT 51,000,000
<br />La -rat u- - - -
<br />X
<br />ANY AUTO
<br />BODILY INJURY (Per person) $
<br />OWNED SCHEDULED
<br />AUTOS ONLY __ AUTOS
<br />BODILY Peracadenl
<br />( ) $
<br />HIRED NON -OWNED
<br />_ _
<br />PROPERIYDAMAGE $
<br />AUTOS ONLY AUTOS ONLY
<br />..(per gccldspt
<br />Ownad?lilred Comp/Coll S Ded's $1000
<br />A X UHIBRELLALIAS X OCCUR I
<br />I
<br />6057362679
<br />4/1/2019 4/1/2020 EACH OCCURRENCE
<br />5 25,000,000
<br />_ _
<br />— "CESSL.IAR 1CLAIMS-MADEI
<br />AGGREGATE
<br />$25,000,000
<br />DE0 X RMNTION S
<br />S
<br />B
<br />WORKERS COMPENSATION
<br />6057544401
<br />4/1/2019
<br />4/1/2020
<br />X I gTATUTE OERTH-
<br />8
<br />AND EMPLOYERS' LIABILITY YIN
<br />6057544415
<br />4/1/2019
<br />4/1/2020
<br />"
<br />E.L" EACH ACCIDENT
<br />ANYPROPRIETOR/PARTNER/EXECUTIVE
<br />$ 1,000,000
<br />OFFICER/MEMBER EXCLUDED? ❑
<br />N / A
<br />-
<br />E,L DISEASE -EA EMPLOYEE
<br />(Mandatory in NH)
<br />S 1,000,000
<br />If yes, describe under
<br />-- —
<br />DESCRIPTION OF OPERATIONS below
<br />E.L_ DISEASE - POLICY LIMIT
<br />S 1.000.000
<br />C Professional Liability
<br />652092957 4/1/2019 4/1/2020 Limit $10,000,000/
<br />Agg $10,000,000
<br />Claims Made Form
<br />Deductible $100,000
<br />Retro Date 04/01/2007
<br />I
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required)
<br />Re: On -Call ITIS Agreement
<br />City of Santa Ana, its officers, employees, agents, volunteers and representatives are designated as Additional Insured with respects General Liability.
<br />REVIEWED & APPROVED
<br />By RISk MANAGEMENT DIVISION
<br />L,tr< I WIL A I t r1ULUtK N1-110 1 M 11114 _ GANOtLLA l WN
<br />FRANC:INE R. VILLAREAL
<br />City of Santa Ana
<br />Risk Management Division
<br />20 Civic Center Plaza
<br />Santa Ana CA 92702
<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 />Vt. ,
<br />© 1988-2015 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
<br />
|