|
A+CQRL. CERTIFICATE OF LIABILITY INSURANCE
<br />DATE(MM/DD/YYYY)
<br />1 3/29/2017
<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 />Woodruff -Sawyer & Co.
<br />50 California Street, Floor 12
<br />San Francisco CA 94111
<br />CONTACT
<br />NAME: Amber Wisher
<br />PHONE 949-435-7382 FAx 949 476-3118
<br />A/c.Ne. Exn: c Nap
<br />EMAIL , awisher@wsandco.com
<br />INSURERS AFFORDING COVERAGE
<br />NAIC #
<br />INSURER A: Illinois Union Insurance Company
<br />27960
<br />INSURED ITERINC-01
<br />INSURER B :American Guarantee and Liabilityn
<br />26247
<br />Iteris, Inc.
<br />1700 Carnegie Avenue, Suite 100
<br />Santa Ana CA 92705-5551
<br />INSURERC:American Zurich Insurance Compa__g
<br />40142
<br />INSURER
<br />-
<br />INSURER E :
<br />INSURER F :
<br />COVERAGES CFRTIFICATF NIIMRFR— 1963405439 RG\/ICinCV NI1"P130•
<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 />---- --
<br />TYPE OF INSURANCE
<br />INSO
<br />WVID
<br />POLICY NUMBER
<br />POLICY EFF
<br />MMIDDIYYYY
<br />POLICY EXP
<br />M /DD/YYYY
<br />v
<br />LIMITS
<br />C
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />Y
<br />CP0553288003
<br />4/1/2017
<br />4/1/2018
<br />EACH OCCURRENCE
<br />$2,000,000
<br />DAMAGE f0 RENT€—----"'
<br />SES_(Ea occurrence)
<br />$2,000,000
<br />CLAIMS -MADE X OCCUR
<br />_EEE
<br />MED EXP (Any one person)
<br />X
<br />BI Ded, None
<br />_
<br />PERSONAL &ADV INJURY
<br />_$15,000
<br />$2,000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />GENERAL AGGREGATE
<br />$4,000,000
<br />X POLICY ❑ JECTPRO- 1 1 LOC
<br />PRODUCTS-COMP/OPAGG
<br />-_ ---
<br />$4,000,000
<br />OTHER:
<br />$--- --
<br />B
<br />AUTOMOBILE
<br />LIABILITY
<br />CP0553288003
<br />4/1/2017
<br />4/1/2018
<br />COMBINED SINGLE LIMIT
<br />61accldentJ_
<br />$1,000,000
<br />BODILY INJURY (Per person)
<br />$
<br />X
<br />ANYAUTO
<br />ALLOWNED SCHEDULED
<br />BODILY INJURY (Per —accident)
<br />$
<br />- NON -OWNED
<br />HIREDAUTOS AUTOS
<br />RT�YDAMA—GS--
<br />(Per accldent)`
<br />$
<br />Owned/Hired Comp/Coll
<br />$Ded's $500
<br />B
<br />X
<br />UMBRELLA LIAB
<br />X
<br />OCCUR
<br />AUC653288103
<br />4/1/2017
<br />4/1/2018
<br />EACH OCCURRENCE
<br />$25,000,000
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />AGGREGATE
<br />$25,000,000
<br />DED X RETENTION$0
<br />$
<br />C
<br />WORKERS COMPENSATION
<br />WC019188401
<br />4/1/2017
<br />4l1/2018
<br />X PER OTH-
<br />STATUTE ER_____
<br />AND EMPLOYERS'LIABILITY y/N
<br />E.L. EACH ACCIDENT
<br />------
<br />_
<br />$1,000,000
<br />ANY PROPRIETOR/PARTNER/EXECUTIVE ❑
<br />OFFICER/MEMBER EXCLUDED?
<br />NIA A
<br />--
<br />E.L. DISEASE- EA EMPLOYEE
<br />-- --
<br />- _.—
<br />$1,000,000
<br />(Mandatory In NH)
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE -POLICY LIMIT
<br />—
<br />$1.000.000
<br />A
<br />Professional Liability
<br />G21656045014
<br />4/112017
<br />4/1/2018
<br />Limit $10,000,000/ Agg $10,000,000
<br />Claims Made Form
<br />Deductible $50,000
<br />Retro-Date 01/01/1991
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached It 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
<br />Liability per form attached.
<br />F L Vdd Wd d C BY EllNICE HER DIA (PC OF�
<br />Santa Ana, City of
<br />Attn: Zed Kekula
<br />20 Civic Center Plaza, M-30
<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 />REPRESENTATIVE
<br />W •I auu-G1.174 Ak;UKu L:UKVUKA I IUN. All rights reserved.
<br />ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD
<br />
|