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A RV CERTIFICATE OF LIABILITY INSURANCE
<br />ATE(MMtD
<br />7D"YY„'
<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 certificate does not confer rights to the certificate holder In lieu of such endorsements).
<br />PRODUCER Bill Douglas Kouris Insurance Agency,lnc
<br />NAME CT
<br />10345 Danichris Way
<br />PHONE 916-236.5641 916-685.9571
<br />ExtipL A/c N°
<br />Elk Grave CA 95757
<br />EMAINo.
<br />ADDREss: bdkinsurance@gmall.com
<br />INSURERIS1AFF2RDIN000VERAGE
<br />NAiC#_-
<br />INSURER A:Houston Casualty Company
<br />._
<br />a237d
<br />INSURED BenderRosenthal, inc.
<br />INSURERB;Columbia Insurance Company
<br />4400 Auburn Boulevard, Suite 102
<br />1NSURER C.:Sentinel Insurance Company, Limited
<br />111000
<br />Sacramento CA 95841
<br />INSURER 0, Granite State Insurance Company
<br />13102_._..._........_.
<br />INSURER E : Mercer Insurance Company
<br />INSURER F
<br />GUVEKALahB GhK11HUAIE NUMBER' RFVIRIntd 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 />KKK---._.__.__.___,..w....,_.• A47DL Sit 6R _.�.._ POLICY EFF ...._Pot-' IG'V EXP-.._.,_.____.._...__,,.,_.,...:......:.._.....,...................-..........._..... ............. .....
<br />LTR TYPEOFINSURANCE POLICYNUMSER MMIDD M 1DD/YYYY LIMITS
<br />C
<br />✓
<br />COMMERCIAL GENERAL LIABILITY
<br />CLAIMS MADE �✓ occuR
<br />57 SBA TX3133
<br />07/21/2016
<br />071211201E
<br />EACHOCCURRENCE
<br />?..FiEti.�'1��.tE845�!!!LaRS�,_•.....5....
<br />$2,000,000
<br />_.:.:............:......
<br />300J 000
<br />_ ..�._........_.__.._....._.
<br />........................_..................._............ --- —
<br />MED EXP.SAr_kY on@.L h) ....
<br />$10,000
<br />PERSONAL& ADV INJURY
<br />$2,000,000
<br />_,_,•___.._............ ._...___.._._..__.._._._...,...
<br />GEN'L
<br />✓
<br />AGGREGATE LIMIT APPLIES PER:
<br />POLICY PRO- D
<br />JECT LOC
<br />GENERAL AGGREGATE
<br />_. _ .w ..._...
<br />PRODUCTS-COMPIOPAGG
<br />$4,000,000
<br />__..____....,._...
<br />$4,000,000
<br />$
<br />OTHER
<br />AUTOMOBILE LIABILITY
<br />ANYAUTO
<br />✓
<br />t L/
<br />�LT! I LE LIMIT
<br />—_ _J__._......
<br />BODILYINJURY(Perperson)
<br />$1 000 000
<br />$
<br />B
<br />OWNED yr SCHEDULED
<br />AUTOSONLY AUTOS
<br />✓ AiURTOSONLY ✓ ANON-OWNEDMOS ONLY
<br />71APR351846
<br />D611412017
<br />0611412018
<br />BODILY )
<br />PROPERTY�TwiAGE """"
<br />..1{P j cddent.._..._.....__.......... _
<br />.5-_____._ _
<br />$"""""' _._.......
<br />$
<br />E
<br />UM13RELLALIAS ✓ OCCUR
<br />✓ I
<br />✓
<br />27305298
<br />1212016
<br />07/1212018
<br />EACH OCCURRENCE
<br />$4r000,000
<br />yI
<br />EXCESSLIAB CLAIMlyMADE
<br />GL, Auto and WC form
<br />r
<br />AGGREGATE
<br />$4,000,000
<br />DED F_TiRETENTION $
<br />$
<br />D
<br />WORKERS COMPENSATION
<br />AND EMPLOY RS'LiABILIITY YiN
<br />ANYPROPRIETORIPARTNERIEXECUTIVE
<br />OFFICERWEMBEREXCLUOEb? [NJ
<br />(MandatoryinNN)
<br />NIA
<br />✓
<br />WC019397574
<br />i06/0112017
<br />0810112016
<br />✓ STA __ .FJ;.._,,,•.,,__,
<br />E.L.EACHACCIDENT
<br />E.DISEASE-EAEMPLOYEE
<br />A.L.---•
<br />._„_•___ _
<br />1 O0O OOO
<br />$ ,_ i _
<br />$1,000,000_................
<br />If yyeess� describe under
<br />DESCRIPTIONOFOPERATIONStelow
<br />---
<br />E.LDISEASE -POLICY LIMIT
<br />_ .....-._.:.
<br />$1,000,000
<br />H716-108786
<br />A
<br />Professional Liabili tY
<br />Q
<br />Q
<br />Deductible 15 000
<br />,
<br />113012016
<br />11l3012017
<br />$2,000,000 Per Occurrent:
<br />$2,000,000 Aggregate
<br />CLAIMS MADE
<br />(
<br />Retro Date 11/30/99
<br />DESCRIPTION OF OPERATIONS 1 LOCATIONS r VEHICLES (ACORD 101, Additional Remarks Schaduto, may be attached irmors apace to required)
<br />General Liability Policy excludes claims arising out of the performance of professional services.
<br />30 Days Notice of Cancellation (10 Days for Non -Payment of Premium)
<br />Job: On -Call Right of Way Property Appraisal Services
<br />BUSINESS LIABILITY ADDITIONAL INSURED: City of Santa Ana, its officers, employees, agents, volunteers, and representatives and any
<br />other person named in the written contract between the Named Insured and the Certificate Holder.
<br />orkers' Compensation Additional Insured, 30 Day Cancellation WC990917, and Waiver of Subrogation WC04 361.
<br />REVIEWED BY: EUNICE HEREDIA, (PG OF
<br />of Santa Ana
<br />ivic Center Plaza (M-30)
<br />lox 1988
<br />a Ana, CA 92702.1988
<br />Ly, MLy@santa-ana.org
<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 />CORPORATION, All rights reserved.
<br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
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