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�® CERTIFICATE OF LIABILITY INSURANCE <br />DATE (MMID019 <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 notconfer rights to the certificate holder in lieu of such endorsement(s). <br />PRODUCER ICA Insurance Services <br />130 Vantis, Suite 250 <br />Aliso Viejo, CA 92656 <br />CONTACT BettyTran <br />PHONE FAX <br />A/C. No EAI, 949-297-5962 AIc No: 949-297-5960 <br />E-MIL <br />ADDRESS: bett .tran ioausa.com <br />INSURER(S) AFFORDING COVERAGE <br />NAIC# <br />INSURER A: RLI Insurance Company <br />13056 <br />www.loausa.com CA License #OE67768 <br />INSURED <br />D. Woolley & Associates, Inc.; <br />Harbinger Analytics Croup <br />INSURER B : <br />INSURER C: <br />INSURER D: <br />2832 Walnut Avenue, Suite <br />Tustin CA 92780 <br />INSURER E: <br />INSURER F : <br />COVERAGES CERTIFICATE NUMBER- Rn1AT/nA RFVIAION NIIkaRFR. <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 <br />LTR <br />TYPE OF INSURANCEINS12 <br />ADDL <br />SUBR <br />WVQ <br />POLICY NUMBER <br />POLICY EFF <br />MWDDIYYYYI <br />POLICY EXP <br />(MMIDDIYYYYI <br />LIMITS <br />COMMERCIAL GENERAL LIABILITY <br />CLAIMS -MADE OCCUR <br />✓ <br />Prim/NonCon <br />`/ <br />`/ <br />PSBOOD1377 <br />Scheduled Al Endt <br />#PPB3130212 <br />Professional Services <br />2/11/2019 <br />2/11/2020 <br />EACH OCCURRENCE <br />$2,000000 <br />DAMAGE T RE <br />PREMISES Ea occurrence <br />$1,000000 <br />✓ <br />MED EXP (Any one person) <br />$10 000 <br />Wvrof Subr <br />PERSONAL&ADV INJURY <br />$2,000000 <br />✓ <br />performed by the Insured <br />AGGREGATE LIMIT APPLIES PER: <br />GENERAL AGGREGATE <br />$4,000,000 <br />DEVIL <br />are Excluded <br />POLICY ❑✓ PRO- <br />JECT [V] LOD <br />PRODUCTS - COMP/OP AGG <br />$4,000000 <br />$ <br />OTHER: <br />A <br />AUTOMOBILE <br />LIABILITY <br />ANY AUTO <br />OWNED SCHEDULED <br />AUTOS ONLY Auros <br />HIRED NON -OWNED <br />Auros ONLY ✓ Auros ONLY <br />✓ <br />✓ <br />PSA0001203 <br />Designated Insured Endt <br />#CA20481013; Prim/NonCon <br />and Blkt Wvr of Subr <br />included on pg 2 of Form <br />2/11/2019 <br />2/11/2020 <br />OMBINEDISINGLE LIMITE. accide <br />$1000,000 <br />BODILY INJURY (Perpereon) <br />$ <br />BODILY INJURY (Per accident) <br />$ <br />✓ <br />-PROPERTYt AGE <br />Per ecclaent <br />den <br />$ <br />✓ <br />Prim/NonCon ✓ Wvr of Subr <br />#PPA3000313 <br />A <br />UMDRELLA LIAR <br />OCCUR <br />PSE0001266 <br />2/11/2019 <br />2/11/2020 <br />EACHOCCURRENCE <br />$4,000000 <br />✓ <br />EXCESS LIAR <br />CLAIMS -MADE <br />Excludes Professional <br />Liability <br />AGGREGATE <br />$4,000000 <br />DED I I RETENTION $ <br />$ <br />A <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY YIN <br />OF IC RAYPROPMEMBER EXCLUDED?ECUTIVE FN <br />NIA <br />✓ <br />PSW0001324 <br />Waiver of Subrogation <br />Endt#WC0403060484 <br />2/11/2019 <br />2/11/2020 <br />,/ sEnruTE 0RH <br />E,L EACH ACCIDENT <br />$1000,000 <br />E.L. DISEASE -EA EMPLOYEE <br />$ 000000 <br />(Mandatory In NH) <br />f yes, describe under <br />DESCRIPTION OF OPERATIONS below <br />E.L. DISEASE -POLICY LIMIT <br />$1000000 <br />A <br />Professional Liability <br />RDP0031627 <br />2/11/2019 <br />2/11/2020 <br />$1,000000 Each Claim <br />Claims -Made <br />$2,000:000 Aggregate <br />DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 1a1, Additional Remarks Schedule, may be attached if more space is mmulred) <br />Certificate Holder is an Additional Insured with respect to General Liability (GL) and Automobile Liability but only when required by written contract <br />with the Insured prior to an occurrence as per Endorsements noted above. GL includes Separation of Insureds and Contractual Liability per limitations <br />in the BusinessOwners' Coverage form. A Workers' Compensation Waiver of Subrogation as noted above is included for the person or organization named <br />in the Schedule that are parties to a contract requiring this Endorsement, provided that contract is executed before the loss. Coverage subject to all <br />policy terms, conditions, limitations and exclusions. 30 Day Notice of Cancellation/10 Days for Non -Payment in accordance with policy provisions. <br />■ea.�uuva�acv�enac� <br />City of Santa Ana, their employees, <br />officers and directors <br />20 Civic Center Plaza (M-30) <br />PO Box 1988 <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 />(AVG) Alicia K. Igram CC�t_J v <br />©1988-2016 ACORD CORPORATION. All Hants reserved <br />ACORD 26 (2016/03) <br />The ACORD name and logo are registered marks of ACORD <br />50140704 12/19-20 GL/AUT0/8%CESS/41C/PL I Donna E6quivel 17/24/2019 10:10:36 AM (PDT) I Page 1 of 5 <br />