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PSOMAS 7 - 2016
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PSOMAS 7 - 2016
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Last modified
3/6/2017 10:16:48 AM
Creation date
6/1/2016 10:55:11 AM
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Contracts
Company Name
PSOMAS
Contract #
A-2016-058
Agency
PUBLIC WORKS
Council Approval Date
4/5/2016
Expiration Date
4/4/2017
Insurance Exp Date
10/15/2016
Destruction Year
2022
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A� a® CERTIFICATE OF LIABILITY INSURANCE <br />5/DATE(M DDrcvyV) <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 />Dealey, Renton &Associates <br />License #0020739 <br />P. O. Box 10550 <br />CONTACT <br />NAME: <br />PHGNE 714- 427 -6810 FAX . 714- 427 -6818 <br />E -MAIL . rise @dealeyrenton.com <br />INSURERS AFFORDING COVERAGE <br />NAIL N <br />Santa Ana CA 92711 -0550 <br />INSURER A:ACE American Insurance Company <br />22667 <br />INSURED PSOMAS <br />INSURER B : <br />$ <br />PSOMAS <br />555 South Flower Street, Suite 4300 <br />Los Angeles CA 90071 <br />INSURER C: <br />$ <br />INSE D: <br />MED EXP IAry one person) <br />$ <br />INSURURER R E <br />INSURER F <br />COVERAGES CERTIFICATE NUMBER: 1918420735 RFVISInN NIIMRFR• <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 />INSO <br />Me <br />POLICY NUMBER <br />POLICY EFF <br />MM /DDIYVYY <br />POLICY EXP <br />MMIDDIYVYV <br />LIMITS <br />COMMERCIAL GENERAL LIABILITY <br />CLAIMS -MADE E OCCUR <br />EACH OCCURRENCE <br />$ <br />DA A ET RENTED <br />PREMISES Ea occurrence <br />$ <br />MED EXP IAry one person) <br />$ <br />PERSONAL A ADV INJURY <br />$ <br />AGGREGATE LIMIT APPLIES PER <br />POLICY ❑ PRO- ❑ <br />JECT LOC <br />GENERAL AGGREGATE <br />$ <br />GEN'L <br />PRODUCTS - COMP /OP AGO <br />$ <br />$ <br />OTHER: <br />AUTOMOBILE <br />LIABILITY <br />COMBINED SINGLFTFri <br />Ea accident <br />$ <br />BODILY INJURY (Per person) <br />$ <br />ANY AUTO <br />AUT OWNED SCHEDULED <br />BODILY INJURY (Par accident) <br />$ <br />HIREDAUTOS NON -OWNED <br />AUTOS <br />PROPERTY -DAMAGE <br />Per accident <br />$ <br />UMBRELLA LIAB <br />OCCUR <br />EACH OCCURRENCE <br />$ <br />AGGREGATE <br />$ <br />EXCESS LIAB <br />CLAIMS -MADE <br />DED I RETENTION$ <br />$ <br />WORKERS COMPENSATION <br />PER OTH- <br />AND EMPLOVERS'LIABILITY Y/N <br />STATUTE ER <br />E.L. EACH ACCIDENT <br />$ <br />ANY PROPRIETCRIPARTNERIEXECUTIVE ❑N <br />OFFICER/MEMBER EXCLUDED? <br />/A <br />E.L. DISEASE - EA EMPLOYEE <br />$ <br />(Mandatory In NH) <br />If yes, describe under <br />DE SCRIPTION OF OPERATIONS below <br />E.L. DISEASE - POLICY LIMIT <br />$ <br />A <br />Professional Liability <br />Claims Made <br />G23638381007 <br />10115/2015 <br />10/15/2016 <br />Per Claim $1,000,000 <br />Annual Aggregate $2,000,000 <br />DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (AC ORD 101, Additional Remarks Schedule, may be attached if more space is required) <br />30 Day Notice of Cancellation /10 Day notice for Non - Payment of Prem <br />2SAN051100, City of Santa Ana On -Call Engineering Services Agreement 14 -037, PWA (A- 2008 -219 & A- 2015 -167), GIS Project. <br />REVIEWED BY: _ EUNICE HEREDIA (PG /OF `) <br />CERTIFICATE HOLDER CANCELLATION <br />City of Santa Ana, PWA - Design Engineering <br />Attn: Monica M. Suter, PE, TE, PTOE <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 />20 Civic Center Plaza, M -36 <br />Santa Ana CA 92702 <br />AUTHORIZED REPRESENTATIVE <br />@ 1988.2014 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD <br />
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