r �
W CERTIFICATE OF LIABILITY INSURANCE
DATE (MM/DD/YYYY)
I 6/3/2022
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed.
If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
CONTACT
PRODUCER
AssuredPartners of Washington, LLC
A/E Insurance Services
19689 7th Ave NE, Ste 183, PMB #369
Poulsbo WA 98370
INSURED
Sagecrest Planning+Environmental
27128 Paseo Espada Suite 1524
San Juan Capistrano CA 92675
SAGEPLA-01
I PFi E, Robyn Catania CA LIC # 0K48649
sn/I No Lap: 360-626-9535
E-MAIL
ADDRESS: robyn.cataniaftassuredpartners.com
INSURER(SI AFFORDING COVERAGE NAIC #
INSURERA: Travelers Property Casualty Company of America 25674 I INSURER B: Beazley Insurance Company Inc 37540
INSURER C
I!
INSURER D
�{a c, Ne};_360-626.9535
INSURER E
INSURER F
COVERAGES CERTIFICATE NUMBER: 212637526 REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR ADOL SUBR POLICY EFF POLICY EXP
TYPE OF INSURANCE
LTR INS/ WVn POLICY NUMBER (MM/DD/YYYY1 IMM/DD/YYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY Y Y 6805J742889
CLAIMS -MADE n OCCUR
GEN- 'L AGGREGATE LIMIT APPLIES PER:
I POLICY X PRO -
LOC
JECT
OTHER:
A AUTOMOBILE LIABILITY
X - ANY AUTO
OWNED
AUTOS ONLY
HIRED
AUTOS ONLY
SCHEDULED
AUTOS
NON -OWNED
AUTOS ONLY
UMBRELLA LIAB
EXCESS LIAB
OCCUR
CLAIMS -MADE
DED RETENTION $
A WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
A NYPR O P R I ETOR/PART N E R/EXE C UTI V E
OFFICER/MEMBER EXCLUDED?
(Mandatory in NH)
If yes, describe under
DESCRIPTION OF OPERATIONS below
B Professional Liab;Claims Made V1 EEB6220501
YIN
Y Y BA8R626254
NIA
Y UB5J743745
6/1/2022 6/1/2023
6/1/2022 6/1/2023
6/1/2022 6/1/2023
EACH OCCURRENCE
lalatiE 7T:1 Ramp
PREMISES (Ea aCCURersc01
MED EXP (Any one person)
PERSONAL B ADV INJURY
GENERAL AGGREGATE
PRODUCTS - COMP/OP AGG
COMBINED SINGLE LIMIT
{Ea acicidantl
BODILY INJURY (Per person)
$ 2000,000
$ t000,000
$ 5,000
$ 2,000,000
$ 4,000,000
$ 4,000,000
$ 1,000,000
BODILY INJURY (Per accident) $
PROPERTY DAMAGE
Mar accidenll
EACH OCCURRENCE $
AGGREGATE $
X PER OTH-
,STATUTE I ER
E.L. EACH ACCIDENT
$ 1,000,000
E.L, DISEASE - EA EMPLOYEE $ 1,000.000
E.L. DISEASE - POLICY LIMIT $ 1,000,000
6/1/2022 6/1/2023 Per Claim 2,000,000
Aggregate 4,000,000
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached 0 more space is required) The certificate holder is an additional insured per the attached.
The City of Placentia and its elected and appointed boards, officers, officials, agents, employees, and volunteers are additional insureds with respect to liability arising out of activities performed by or on behalf of the Consultant pursuant to its contract with the City; products and completed operations of the Consultant; premises owned, occupied or used by the Consultant; automobiles owned, leased, hired, or borrowed by the Consultant on the Commercial General Liability and Auto Liability when required by written contract or agreement regarding activities by or on behalf of the Named Insured. The Commercial General Liability insurance is primary insurance and any other insurance maintained by the Additional Insured shall be excess only and non-contributing with this insurance A waiver of subrogation applies to the Commercial General Liability, Auto Liability in favor of the Additional Insured.
CERTIFICATE HOLDER CANCELLATION
City of Placentia
401 E Chapman Avenue
Placentia CA 92870
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS.
AURIZED REPRESENTATIVE
ti
© 1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD