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Client#: 1086878
<br />INTERCON35
<br />ACORDTM CERTIFICATE OF LIABILITY INSURANCE
<br />rDATE(MM/DD/YYYY)
<br />R
<br />LTRS
<br />12/13/2018
<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 any rights to the certificate holder in lieu of such endorsement(s).
<br />PRODUCER
<br />CONTACT
<br />NAME:
<br />USI Colorado, LLC Prof Liab
<br />PHONE FAX
<br />E A Lo, Ed): 800 873-8500 (XC, No :
<br />P.O. BOX 7050
<br />11/14/2019
<br />Englewood, CO 80155
<br />ADDRESS:
<br />MED EXP (Any one person) $10,000
<br />800 873-8500
<br />INSURER(S) AFFORDING COVERAGE NAIC #
<br />INSURER A : Travelers Property Cas. Co. of America
<br />25674
<br />INSURED
<br />INSURER B : XL Specialty Insurance Company
<br />137885
<br />Interwest Consulting Group Inc
<br />P.O. Box 18330
<br />INSURER C
<br />INSURER D:
<br />Boulder, CO 80308
<br />GENERAL AGGREGATE $ 2,000,000
<br />E :
<br />rINSURER
<br />INSURER F:
<br />COVERAGES CERTIFICATE NUMBER: REVISION NUMRER-
<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 />R
<br />LTRS
<br />TYPE OF INSURANCE
<br />ADDL
<br />INSR
<br />SUBR
<br />WVD
<br />POLICY NUMBER
<br />POLICY EFF
<br />MM/DD/YYYY
<br />POLICY EXP
<br />MM/DD/YYYY
<br />LIMITS
<br />A
<br />X1 COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE X OCCUR
<br />❑
<br />Y
<br />Y
<br />6806H441235
<br />11/14/2018
<br />11/14/2019
<br />EACHOCCURRENCE $1000000
<br />°�EMISEs� a occurrence $1,000,000
<br />MED EXP (Any one person) $10,000
<br />PERSONAL & ADV INJURY $1,000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />POLICY X ECCT LCC
<br />GENERAL AGGREGATE $ 2,000,000
<br />PRODUCTS - COMP/OP AGG $2,000,000
<br />$
<br />OTHER:
<br />A
<br />AUTOMOBILE LIABILITY
<br />Y
<br />Y
<br />BAOJ093233
<br />11/14/2018
<br />11/14/201 9
<br />COMBINED SINGLE LIMIT
<br />Ea ccid.in'l $1,000,000
<br />X ANY AUTO
<br />BODILY INJURY (Per person) $
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />X AUTOS ONLY X NON -OWNED
<br />AUTOS ONLY
<br />BODILY INJURY (Per accident) $
<br />PROPERTY DAMAGE $
<br />Per accident
<br />A
<br />j(I
<br />UMBRELLA LIAB
<br />I X
<br />OCCUR
<br />Y
<br />Y
<br />CUP2F178249
<br />11/14/2018
<br />11/14/2019
<br />EACH OCCURRENCE s4,000,000
<br />EXCESS LIAB
<br />ffJ
<br />CLAIMS -MADE
<br />AGGREGATE s4.000.000
<br />DED I X RETENTION $O
<br />$
<br />A
<br />WORKERS COMPENSATIONY
<br />AND EMPLOYERS' LIABILITY
<br />ANY PROPRIETOR/PARTNER/EXECUTIVE Y / N
<br />OFFICER/MEMBER EXCLUDED? N
<br />N/A
<br />UB81034006
<br />11/14/201811/14/201
<br />X PER OTH-
<br />E.L. EACH ACCIDENT $1,000,000
<br />E.L. DISEASE - EA EMPLOYEE $1,000,000
<br />_
<br />(Mandatory in NH)
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE- POLICY LIMIT $1,000,000
<br />B
<br />Professional Liab
<br />Y
<br />DPR9933966
<br />11/14/2018
<br />11/14/2019
<br />$2,000,000 per claim
<br />Pollution Liab
<br />$5,000,000 annl aggr.
<br />Claims Made
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required)
<br />Additional Insured: City of Santa Ana, its officers, employees, agents, volunteers and representatives.
<br />All policies include 30 Day Notice of Cancellation in favor of the City of Santa Ana.
<br />As required by written contract or written agreement, the following provisions apply subject to the policy
<br />terms, conditions, limitations and exclusions: The Certificate Holder and owner are included asmatic
<br />(See Attached Descriptions) REVIEWED BY: 01 EUNICE HEREDIA (PG I OF
<br />City of Santa Ana
<br />20 Civic Center Plaza (M-30)
<br />PO Box 1988
<br />Santa Ana, CA 92702-1988
<br />ACORD 25 (2016/03) 1 Of 2
<br />#S24475055/M24330283
<br />CLLR
<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 />©1988-2015 ACORD CORPORATION. All rights reserved.
<br />The ACORD name and logo are registered marks of ACORD
<br />SHAZP
<br />
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