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Client#: 25320
<br />KIMLHORN
<br />ACORDTM CERTIFICATE OF LIABILITY INSURANCE
<br />E (MMIDDI
<br />DA 8//211201721/2017 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(les) 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 />Greyling Ins. Brokerage/EPIC
<br />3780 Mansell Road, Suite 370
<br />NAME: NTACT Jerry Noyola
<br />PHONE 770.552.4225 F"x 866.550.4082
<br />E ALo Ext: AIC, No:
<br />ADDRESS: jerry.noyola@greyling.com
<br />Alpharetta, GA 30022
<br />INSURER(S) AFFORDING COVERAGE
<br />NAIC#
<br />INSURERA: National Union Fire Ins. Co.
<br />19445
<br />04/01/2018
<br />INSURED
<br />INSURER B: Aspen American Insurance Compan
<br />43460
<br />Kimley-Horn and Associates, Inc.
<br />421 Fayetteville Street, Suite 600
<br />Raleigh, NC 27601
<br />New NHampshire Ins. Co.
<br />INSURER C: P
<br />23841
<br />INSURER ❑;Lloyds of London
<br />0$5202
<br />INSURER E:
<br />MED EXP (Any one person) $25,000
<br />INSURER F:
<br />X ContractualLlab.
<br />COVERAGES CERTIFICATE NUMBER: 17.18 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 />ADDLSUBR
<br />INSR
<br />MD
<br />POLICY NUMBER
<br />POLICY EFF
<br />MMIDDIYYYY
<br />POLICY EXP
<br />MMIDD/YYYY
<br />LIMITS
<br />A
<br />X COMMERCIAL GENERAL LIABILITY
<br />5268169
<br />04101/2017
<br />04/01/2018
<br />EACH OCCURRENCE $110001000
<br />CLAIMS -MADE (OCCUR
<br />PREMISESOEaoccurrDence $500000
<br />MED EXP (Any one person) $25,000
<br />X ContractualLlab.
<br />PERSONAL &ADV INJURY $1,000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />GENERAL AGGREGATE $2,000,000
<br />RO-
<br />POLICY [ ]X JEC ® LOC
<br />PRODUCTS - COMP/OP AGG $2,000,000
<br />$
<br />OTHER:
<br />A
<br />AUTOMOBILE
<br />LIABILITY
<br />4489663
<br />4/0112017
<br />041011201
<br />COMBINED SINGLE LIMIT
<br />Eaaccldent $1,000,000
<br />BODILY INJURY (Per person) $
<br />AUTO
<br />JXANY
<br />ALL OWNED SCHEDULED
<br />AUTOS AUTOS
<br />BODILY INJURY (Per accident) $
<br />PROPERTYAMAGED$
<br />Par accident
<br />HIRED AUTOS X NON -OWNED
<br />AUTOS
<br />B
<br />X
<br />UMBRELLA LIAR
<br />X
<br />OCCUR
<br />CX005FT17
<br />4/01/2017
<br />04/01/2018
<br />EACH OCCURRENCE
<br />AGGREGATE s5,000,000
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />DED X RETENTION $O
<br />$
<br />C
<br />A
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY YIN
<br />ANY
<br />EXCLUDED?ECUTIVE
<br />(Mandatory in NH)
<br />NIA
<br />015893685 (AOS)
<br />015893686 (CA)
<br />4/0112017
<br />04/01/2017
<br />04/01/2018
<br />04/01/2018
<br />X PTA U E OTH-
<br />ER
<br />E.L. EACH ACCIDENT $1,000,000
<br />E.L. DISEASE - EA EMPLOYEE $1,000000
<br />If,, describe undo,
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE -POLICY LIMIT $1,000,000
<br />D
<br />Professional Liab
<br />P070831700
<br />04101/2017
<br />04/01/2018
<br />Per Claim $2,000,000
<br />Aggregate $2,000,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS /VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required)
<br />Re: Entitlement Review Services, Sherry Vander Dussen. The City, its officers, employees, agents & WtILL 142 -CL
<br />representatives are named as Additional Insureds with respects to General Liability where required by�II
<br />written contract. The above referenced liability policies with the exception of workers compensation & `{_:'�I'�
<br />professional liability are primary & non-contributory where required by written contract. Separation of GrI I� 1
<br />Insureds applies to the General Liability Policy. Umbrella Follows Form with respects to General, 0D
<br />(See Attached Descriptions)
<br />Cit of Santa Ana SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />City anTHE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />Insurance Administrator ACCORDANCE WITH THE POLICY PROVISIONS.
<br />20 Civic Center Plaza
<br />Santa Ana, CA 92701 AUTHORIZED REPRESENTATIVE
<br />© 1988-2014 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2014101) 1 of 2 The ACORD name and logo are registered marks of ACORD
<br />#S8452241M695961 JNOY1
<br />
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