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Client#: 1086878
<br />INTERCON35
<br />A-2018-078 and A-2018-214 I
<br />ACORD. CERTIFICATE OF LIABILITY INSURANCE
<br />DATE (MMIDD/YYYY)
<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 />USI Colorado, LLC Prof Liab
<br />P.O. Box 7050
<br />Englewood, CO 80155
<br />800 873-8500
<br />CONTACT
<br />NAME:
<br />PHONE FAX
<br />Ext): 800 873-8500 (A/C, No):
<br />E MAILo
<br />ADDRESS:
<br />INSURER(S) AFFORDING COVERAGE NAIC #
<br />av25674
<br />INSURER A :Trelers Properly Cas, Co, of America
<br />INSURED
<br />Interwest Consulting Group Inc
<br />P.O. Box 18330
<br />INSURER B ; XL Speclalty Insurance Company 37885
<br />INSURER C
<br />11/1412019
<br />Boulder, CO 80308
<br />INSURER D:
<br />INSURER E
<br />INSURER F:
<br />COVERAGES CERTIFICATE NUMBER: 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 />LTR
<br />TYPE OF INSURANCE
<br />ADDILSUBR
<br />NSR
<br />WVD
<br />POLICY NUMBER
<br />POLICY EFF
<br />POLICY EXP
<br />LIMITS
<br />A
<br />X COMMERCIAL GENERAL LIABILITY
<br />Y
<br />Y
<br />68061-1441235
<br />11/14/2018
<br />11/1412019
<br />EACHOCTCURRENCE $1,000,000
<br />CLAIMS -MADE � OCCUR
<br />PREMISES Ea 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 />PRO -
<br />POLICY JECT LOC
<br />GENERAL AGGREGATE $ 2,000,000
<br />_
<br />PRODUCTS-COMP/OPAGG $2,000,000
<br />$
<br />OTHER:
<br />A
<br />AUTOMOBILE
<br />LIABILITY
<br />Y
<br />Y
<br />BAOJ093233
<br />11/14/2018
<br />11/14/201
<br />COacccidentSINGLELIMiT $1,000,000_
<br />BODILY INJURY (Per person) $
<br />X
<br />ANY AUTO
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />BODILY INJURY (Per accident) $
<br />PROPERTY DAMAGE
<br />Per accident)$
<br />X
<br />HIRED NON -OWNED
<br />AUTOS ONLY X AUTOS ONLY
<br />A
<br />X
<br />UMBRELLA LIAB
<br />X
<br />OCCUR
<br />Y
<br />Y
<br />CUP2F178249
<br />11/14/2018
<br />11/14/2019
<br />EACH OCCURRENCE s4,000,000
<br />AGGREGATE s4,000,000
<br />EXCESS LIAR
<br />CLAIMS -MADE
<br />DEC) I X RETENTION $O
<br />$
<br />A
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY Y/N
<br />ANY PROPRIETOR/PARTNER/EXECUTIVE
<br />OFFICERIMEMBER EXCLUDED? [N]
<br />(Mandatory In NH)
<br />N / A
<br />Y
<br />U138J034006
<br />11/14/2018
<br />11/14/2019
<br />X gER UTE OTH-
<br />E.L. EACH ACCIDENT $1,000000
<br />E.L. DISEASE - EA EMPLOYEE $1,000,000
<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 I LOCATIONS I 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 as Automatic n
<br />(See Attached Descriptions)
<br />v
<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 />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 />i I
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