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NICHCON-02
<br />AUSTINA
<br />'4� R� CERTIFICATE OF LIABILITY INSURANCE
<br />DAT/16/2D/YYYY)
<br />2/16/2018
<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 endorsement(s).
<br />PRODUCER License # OE67768
<br />IDA Insurance Services
<br />4370 La Jolla Village Drive
<br />Suite 600
<br />CONTACT Erica Wilson
<br />NAME:
<br />PHONE FAX
<br />A/c, No, Et); (858) 754-0063 50233 A/c, No):(619) 574-6288
<br />E-MAIL rca.son Ioausa.com
<br />ADDRESS: Erica.Wilson@ioausa.com
<br />San Diego, CA 92122
<br />AFFORDING COVERAGE
<br />NAIC #
<br />INSURER A:RLI Insurance Company
<br />13056
<br />INSURED
<br />INSURER B: Crum 8r Forster Specialty Insurance Company
<br />44520
<br />INSURERC:
<br />Nichols Consulting Engineers, CHTD
<br />INSURERD:
<br />1885 S. Arlington Ave., #111
<br />Reno, NV 89509
<br />INSURER E :
<br />INSURER F :
<br />_
<br />CCIVFRAnFS CFRTIFICeTF NIIMRFR• RFVI41n1J nt11MRFo-
<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 LTRTYPE
<br />OF INSURANCE
<br />A DL!
<br />UBR
<br />POLICY NUMBER
<br />MMLDICY EFF POLICY EXP
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />EACH
<br />$ 1,000,000
<br />_OCCURRENCE-.
<br />SAGE TO RENTED
<br />$ 1,000,000
<br />CLAIMS -MADE X OCCUR
<br />X
<br />PSB0003222 05/17/2017 05/17/2018
<br />X
<br />Cont Liab/Sev of Int
<br />MLD EXP (Any oneperson)
<br />$ 10,000
<br />PERSONAL & ADV INJURY
<br />S 1,000,000
<br />AGGREGATE LIMIT APPLIES PER:
<br />POLICY jE� LOC
<br />GENERAL AGGREGATE
<br />$ 2,000.000
<br />GEN'L
<br />PRODUCTS - COMP/OP AGG
<br />$ 2,000,000
<br />Deductible
<br />I S 0
<br />OTHER:
<br />A
<br />AUTOMOBILE
<br />X
<br />LIABILITY
<br />ANY AUTO
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />X
<br />IPSA0001184
<br />05/17/2017 05/17/2018
<br />COMBINED SINGLE LIMIT
<br />(Ea accident)
<br />BODILY INJURY Perperson)$
<br />$ 1,00 ,OOO
<br />BODILY INJURY Per accident
<br />$
<br />Parr a cident AGE
<br />$
<br />X
<br />y� ED
<br />AUTOS ONLY AUTOS ONNIY
<br />Comp.: $ 500 X Coll,: $ 500
<br />,
<br />A
<br />UMBRELLA LIAB X OCCUR
<br />j !
<br />EACH OCCURRENCE
<br />$ 5,000,000
<br />AGGREGATE
<br />X
<br />EXCESS LIAB CLAIMS -MADE
<br />PSE0003030
<br />05/17/2017 05/17/2018
<br />$ 5,000,000
<br />DED RETENTION$
<br />A
<br />WORKERS
<br />AND EMPLOYECOMPENSATION
<br />S N A TILOITI'
<br />ANYPROPRIETOR/PARTNER/EXECUTIVE YIN
<br />OFFICERIMEMBER EXCLUDED? LN
<br />(Mandatory In NH)
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />!
<br />NIA
<br />X 'PSW0001955
<br />05/17/2017 05/1712018
<br />X STATUT ER OTM-
<br />1000,000
<br />E.L. EACH ACCIDENT
<br />E.L. DISEASE - EA EMPLOYE
<br />$ 1,000,000
<br />E.L. DISEASE- POLICY LIMIT
<br />11000,000
<br />B
<br />Prof Liab/Clms Made
<br />PKC105019
<br />05/17/2017 05/17/2018
<br />Per Claim
<br />2,000,000
<br />B
<br />Ded.: $10k Per Claim
<br />PKC105019
<br />05/17/2017 05/17/2018
<br />I
<br />Aggregate
<br />2,000,000
<br />DESCRIPTION OF OPERATIONS / LOCATIONS i VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
<br />Re: Agreement Nos. A-2017-172 and A-2017-290
<br />City of Santa Ana, its officers, employees, agents and representatives are Additional Insured with respect to General and Auto Liability per the attached
<br />endorsements as required by written contract. Insurance is Primary and Non -Contributory. Waiver of Subrogation applies to Workers' Compensation.
<br />30 Days Notice of Cancellation with 10 Days Notice for Non -Payment of Premium in accordance with the policy provisi S.
<br />REVIEWED BY: EUNICE HEREDIA (PG i OF )
<br />City of Santa Ana
<br />20 Civic Center Plaza, M-36
<br />M-36 PO Box 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 />AUTHORIZED REPRESENTATIVE
<br />ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved.
<br />The ACORD name and logo are registered marks of ACORD
<br />
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