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Client#: 25320 KIMLHORN
<br />ACORD,. CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDIYYYV)
<br />6/18/2019
<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 />iMPORTAN f: 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 : CoN Jerry Noy ola
<br />Greyling Ins. Brokerage/EPIC PHONE I-AX
<br />(41C, Nc Ext , 770-552-4225 {wc, NuI; 866-550-4082
<br />3780 Mansell Road, Suite 370 ADORIES , Jerry. noyoia@greyling.com
<br />Alpharetta, GA 30022
<br />INSURER St AFFORDING COVERAGE
<br />NAIC #
<br />INSURER A; National Union Fire Ins. Co.
<br />19445
<br />INSURED
<br />Kimley-Horn and Associates, Inc.
<br />Fayetteville Street, Suite 6O0
<br />Raleigh, NC 27601
<br />Raleigh,
<br />INSURER B ; Aspen American Insurance Company
<br />43460
<br />New Ham
<br />INSURER C ; shire Ins. Co.
<br />P
<br />23841
<br />INSURER D : Lloyds of London
<br />085202
<br />INSURER E:
<br />INSURER F :
<br />COVERAGES CFRTIFIRATF MIIMRFR• to-9n ocvlc In �I .
<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 />INSRpT7L5UHR POLICY EFF POLICY EXP
<br />LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER MMMD/YYYV MM/DD/YYYV LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE �� OCCUR
<br />5268169
<br />4/01/2019
<br />04/011202C
<br />EACH OCCURRENCE
<br />$ 1,000000 _
<br />$500000
<br />DAMAGET RENTED
<br />PREMISES Ea occurrence
<br />X
<br />Contractual Liab.
<br />MED EXP (Any oneperson)
<br />$25 000
<br />_
<br />PERSONAL & ADV INJURY
<br />$ 1 000 000
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />POLICY, ER JECOT LOC
<br />GENERAL AGGREGATE
<br />s2,000,000
<br />PRODUCTS - COMP/OP AGG
<br />$2,000 000
<br />$
<br />OTHER:
<br />A
<br />AUTOMOBILE
<br />LIABILITY
<br />ANY AUTO
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />HIRED NON -OWNED
<br />AUTOS ONLY X AUTOS ONLY
<br />4489663
<br />4/01/2019
<br />04/0112020
<br />COMBINED SINGLE LIMIT
<br />1,000i 000
<br />X
<br />BODILY INJURY (Per person)
<br />$
<br />BODILY INJURY (Per accident)
<br />$
<br />X
<br />PRCi}"+FA 5 WAdE
<br />-{Pur acCidenl)
<br />$
<br />$
<br />$5000000
<br />,�t�
<br />B
<br />UMBRELLA LIAB OCCUR
<br />4/01/2019
<br />04/01/202
<br />CX005FT19
<br />EACH OCCURRENCE
<br />X
<br />-X
<br />EXCESS LIAR CLAIMS -MADE
<br />AGGREGATE
<br />DED X RETENTION O
<br />_
<br />_$5,000,000
<br />$
<br />C
<br />A
<br />WORKERS COMPENSATION
<br />AND FJIAPLOYERS' LIABILITY YIN
<br />ANYPROPRIET4 WPARTNER/EXECUTIVE
<br />OFFICERIMFMIlF.R EXCLUDED? �
<br />N I A
<br />015893685 AOS
<br />( )
<br />015893686 (CA)
<br />4/01l2019
<br />4/01/2019
<br />04/01 /202
<br />04/01/202
<br />PER OTH-
<br />X
<br />E.L. EACH ACCIDENT
<br />$1 000 000
<br />E.L. DISEASE - EA EMPLOYEE
<br />$1 00O 000
<br />(Mandatory In NIi)
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below I
<br />I
<br />B0146LDUSA1904949
<br />E.L. DISEASE - POLICY LIMIT 1
<br />$1,000,000
<br />D
<br />Professional Liab
<br />4/01/2019
<br />04/01/2020, Per Claim $2,000,000
<br />Aggregate $2,000,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may bo attached if more space Is required)
<br />Re: On -Call Agreements A-2015-171, A-2017-108, A-2016-344, A-2017-273, A-2017-025, A-2009-212, A-2018-159
<br />01 & A-2018-160-01. The City of Santa Ana, its officers, employees, agents & representatives are named REVIEWED & APPRO
<br />Additional Insureds with respects to General Liability where required by written contract. The above By Risk MANAGEMENT DIVIS
<br />referenced liability policies with the exception of workers compensation & professional liability are
<br />primary & non-contributory where required by written contract. Separation of Insureds applies to the 7 201f1
<br />la
<br />(See Attached Descriptions) �Im A 0
<br />VCR I I F§LM I C nyt_UCM is AN GE LLA TIUN FDA hI!'IhIC n lkru t Are
<br />City of Santa Ana
<br />Risk Management Division
<br />20 Civic Center Plaza
<br />Santa Ana, CA 92702
<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 />1
<br />In
<br />ACORD 25 (2016103) 1 of 2
<br />#S1641449/M1513917
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<br />JNOY1
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