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<br />,,,.....ny MACIGIN-01
<br />�® CERTIFICATE OF LIABILITY INSURANCE
<br />DAT412512011w)
<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 be endorsed. If SUBROGATION IS WAIVED, subject to
<br />the temps 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 />PRODUCER
<br />CONTACT Tracy Dolan
<br />Wells Fargo Insurance Services USA, Inc.
<br />PHONE FAX
<br />(A!&kNp EetL 91.6 231 1757
<br />-CA DOI LIC #OD08408 (916) 231-1741
<br />ADDRESS tracy.dolan@wellsfargo com
<br />..-.-.-.--- ._ __-_--
<br />11017 Cobblemck Drive, Suite 100
<br />..-_......-._.- ..._ __.____ ...--...-_-.-.-.-.._.______._..
<br />INSURER(S1 AFFORDING COVERAGE NAIC 4
<br />Rancho Cordova, CA 95670-6049
<br />INSURER A: American Automobile Insurance Company
<br />21849
<br />INSURED
<br />INSURER B: Cypress Insurance Company
<br />10855
<br />Macias Gini & O'Connell LLP '
<br />-
<br />INSURER C:
<br />Macias Consulting Group &
<br />INSURER D
<br />Intellibridge Partners LLC
<br />INSURER E
<br />3000 3 St. Ste 300, Sacramento, CA 95816
<br />INSURER F:
<br />COVERAGES CERTIFICATE NUMBER: 26/2162 REVISION NUMBER' RRe h<ln, ,
<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-SJBJECT 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 INSURANCE
<br />ADDLSUBR
<br />INSR
<br />WVD
<br />POLICYNUMBER
<br />POLICY EFF
<br />MWDDIYYYY
<br />POLICY EXP
<br />MMI DrYYTO
<br />LIMITS
<br />A
<br />GENERAL LIABILITY
<br />X COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE 1XI OCCUR
<br />AZC80863843
<br />I$
<br />04/30/2011
<br />04/30/2012
<br />EACH OCCURRENCE
<br />$ 2,OLKI
<br />DAMAGE TO RENTED
<br />PREMISES Es occurrence
<br />$ 1,00D,000
<br />MED EXP(Any one person)
<br />$ 1o,000
<br />PERSONAL &AOV INJURY
<br />$ 2,000,000
<br />GENERAL AGGREGATE
<br />$ 4,000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />X POLICY r PRP Loa
<br />PRODUCTS - COMPIOP AGO
<br />$ - 4,000,000
<br />A
<br />AUTOMOBILE
<br />X
<br />X
<br />LIABILITY
<br />ANY AUTO
<br />ALLOWNED SCHEDULED
<br />AUTOS AUTOS
<br />X NON -OWNED
<br />HIRED AUTOS AUTOS
<br />No Owned Au
<br />AZC80863843
<br />04/30/2011
<br />04/30/2012
<br />Ee BINEDISINGLE LIMIT
<br />$ 2,000,G00
<br />BODILY INJURY (Per person)
<br />$
<br />er acc
<br />BODILY INJURY (PidentI
<br />$
<br />_
<br />PROPERTY DAMAGE
<br />Per accident
<br />$
<br />$
<br />A
<br />X
<br />UMBRELLA LIAR
<br />EXCESS LIAB
<br />X
<br />OCCUR
<br />CLAIMS_MADE
<br />AZC80863843
<br />04/30/2011
<br />04/30/2012
<br />EACH OCCURRENCE
<br />$ 1,000,wo
<br />AGGREGATE
<br />$ 1000,000
<br />DED X RETENTION$ - 0
<br />$ 2,000,000
<br />B
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY YIN
<br />ANY PROPRIETORIPARTNEWEXECUTIVE,000,000
<br />OFFICERlMEMBER EXCLUDE09 �.
<br />(Mandatory in NH)
<br />try.., describe under
<br />DESCRIPTIONOFOPERATIONSbelaw
<br />NIA
<br />3300055235-11
<br />04/30/2011
<br />04/30/2012
<br />X - WG STATU- OTH-
<br />DRY -LIMITS
<br />E.L.EEACH ACCIDENT
<br />_
<br />$
<br />E.L.DISEASE - EA EMPLOYE$
<br />1,000,000
<br />'-'—
<br />E.L. DISEASE -POLICY LIMIT
<br />--
<br />$ 1,000OW
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required)
<br />RE:Audit work performed on behalf of the certificate holde�r�C�P4)ifiEatG holder iS (� royd-additipgal�iipVpwed per the attached AB 9189 08/07 form.
<br />Laura Sti :`,`(Sh�i1l-6�_�
<br />e istantf i" ry Attorne-
<br />CERTIFICATE HOLDER CANCELLATION
<br />City of Santa Ana
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />20 Civic Center Plaza
<br />THE EXPIRATION DATE THEREOF, NOTICE .WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />Santa Ana, CA 92701
<br />AUTHORIZED REPRESENTATIVE
<br />91
<br />BOLTA s
<br />The ACORD name and logo are registered marks of ACORD © 1988-2010 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2010/05)
<br />
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