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CERTIFICATE OF LIABILITY INSURANCE
<br />OATE(MMmDYYYY)
<br />10/23/2019
<br />THIS CERTIFICATE IS ISSUED A5 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 be endorsed. If SUBROGATION IS WAIVED, subject to
<br />the terms and conditions of the policy, certain policies may require an endorsement A statement on this certificate does not confer rights to the
<br />certificate holder In lieu of such endorsement(s).
<br />Pg000CEq
<br />N Ginger Ploli
<br />Degginger McIntosh and Associates
<br />PHONE (425)740-5200 FAXIgasl]go-seal
<br />3977 Harbour Pointe Blvd SW
<br />lop q._ N0:
<br />AllAR:
<br />ADDRESS: ginger@DMAireurance.com
<br />INSURERS AFFORDING COVERAGE
<br />NAIC q
<br />Mukilteo WA 98275
<br />INSURER A: Ri8C__ Inc.
<br />19704
<br />INSURED
<br />INSURER a: American Fire and Casualty Co.
<br />asuCom
<br />Ergometrics 6 Applied Personnel Research, Inc.
<br />INSURER c: American Insurance an
<br />National Testing Network, Inc.
<br />INSURER O:
<br />2122 169th St. SW, Suite 300
<br />INSURER E:
<br />Lynnwood WA 98097
<br />INSURERF:
<br />CR
<br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY
<br />PERIOD
<br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
<br />CERTIFICATE MAYBE 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 />ILTR
<br />TYPE OF INSURANCE
<br />AO
<br />9U.11 BR
<br />POLICYNUMSER
<br />POLICY EFF
<br />MM YEXP
<br />LIMITS
<br />A
<br />GENERAL
<br />LIABILITY
<br />4PL1D9g042.19
<br />0127/2019
<br />10/27/2020
<br />EACH GOCCURRENCE
<br />S 1,000,000
<br />MERCIAL GENERAL LIABILITY
<br />MATO EDence
<br />PREMISES feeo
<br />S 50,000
<br />MED UP (An one person)
<br />S 5,000
<br />CLAIMS -MADE 51 OCCUR
<br />TXDEDUCT19U:
<br />X
<br />PERSONAL A AW INJURY
<br />S 1,0001000
<br />$2,500
<br />GENERALAGGREGATE
<br />S 2,000,000
<br />GENL AGGREGATE LIMT APPLIES PER:
<br />PRODUCTS - COMPIOPAGG
<br />S 2,000,000
<br />X PCLJCYF-1 PRO- La
<br />3
<br />B
<br />AUTOMOBILE
<br />LIABILITY
<br />8229925
<br />O/27/2019
<br />10/27/2020
<br />COMa1NEOSINGLELIMIT
<br />Ea acci n
<br />11000,000
<br />X
<br />GODLY INJURY (Per peon)
<br />rs
<br />S
<br />AAUTO
<br />AU OWNED SCHEDULED
<br />BODILY INJURY (Per accitlen0
<br />S
<br />AUTOS AUTOS
<br />HIREOAUTOS X AUTOS NON-OWNEDF
<br />AUTOS
<br />X
<br />PROPERTY DAMAGE
<br />S
<br />p co
<br />S
<br />C
<br />X
<br />UMBRELLA LIAR
<br />X
<br />OCCUR
<br />0/27/2019
<br />10/27/2020
<br />EACH OCCURRENCE
<br />S 2,000, 000
<br />E%CE9S LIAR
<br />",,:MADE
<br />[OBH8345119
<br />AGGREGATE
<br />S 2,000, 000
<br />pEp 'e RETENTIONS 30, 00
<br />S
<br />A
<br />}Dt%EkkUtKMPL LIXN9AilOW ABILITY
<br />L30040g2.19
<br />I0/2]/2019
<br />0/2]/2020
<br />WL STATU- X OTH-
<br />YIN
<br />ANYPROPRIETORNARTNERSXECUTIVE
<br />OFFICEMMEMSER EXCLUDED] ❑
<br />NIA
<br />A sx0e GAP
<br />E.L. EACH ACCIDENT
<br />S 11000,000
<br />If deorylo NH)
<br />It yen, tlex4ha under
<br />E.L.OISEASE-EAEMPLOYEE
<br />S 1 000,000
<br />E.L.OISEASE-POUCYLIMIT
<br />$ 1 000,000
<br />OESCRIPTION OF OPERATIONS below
<br />A
<br />PROFESSIONAL LIABILITY
<br />sPIL1004042.19
<br />O/27/2019
<br />1D/27/2020
<br />EACH OCCURRENCE $2,000,000
<br />DEDUCTIBLE: $5,000
<br />TRD DATE 06-23-1998
<br />AGGREGATE $3,000,000
<br />DESCRIPTION OF OPERATIONS /LOCATIONS I VEHICLES IAft ch ACORD 101, Additional Remarks Schedule, it more space is required)
<br />City of Santa Ana its officers, employees, agents and representatives are included as Additional Insured
<br />per attached farm WCLP0002CW(1014) with respect to operations of the Nerved Insured. Coverage is
<br />Primary/Non-Contributory per same form. Notice of Cancellation, Non -Renewal and Material Change on
<br />General Liability and Professional Liability applies per attached Endorsement WCLE6047CW(OS/13). All
<br />endorsements apply per required Written Contract, RE: NTN Testing Services
<br />rcorrnrn're unr n _.
<br />LFerrea( - W.&4PPR----....-._
<br />BY ISk MAN AC EMENT DIVIS
<br />1
<br />OHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />HE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />City of Santa Ana �}
<br />Risk Management Division v 1 3 2019
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />AUTHORIZED REPRESENTATIVE
<br />20 Civic Center Plaza
<br />4th Floor
<br />Santa Ana, CA 92702 SAM THA M. LAMBE
<br />T
<br />Ken McIntosh/OGDON
<br />ACORD OR/2010105
<br />••--••-----•-•--r R2 T988-2uTu ACURU CORPORATION. All rights reserved.
<br />INS0251201minU1 The ACORD name and logo are registered marks of ACORD
<br />
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