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<br />?AC?°R°'° CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/VWn <br />12/2/20'1 O <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS <br />CERTIFICATE DOES NOT AFFIRMATNELY OR NEGATNELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES <br />BELOW. TH13 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 certifcate holder is an ADDITIONAL INSURED, the policy(las) must be endorsod_ If SUBROGATION IS WAIVED, subject to <br />the tam>_s and conditiotla of the policy, certain policies may require an endorsement A statement on this certificate does not confer rights to the <br />eertlflcate holder In Iteu of such antloraement a . <br />PRODUCER Insurance OfFtce of America C NTACT NAME: <br />130 Yantis, Suite 250 PHONE 9=297-5962 A/c Nor. sas34?-5gs0 <br />Aliso Viejo, CA 92656 <br />InsuRED JOnnSOn-Frank & ASSOCIateS, Inc. <br />5150 E. Hunter Avenue <br />807 <br />-? A?D? _O?ID ? SURER E: <br />y ` NSUREq F - <br />COVERAGES CERTIFICATE NUMBER• 8898708 REVISION NI <br />rH15 IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POUCY 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 />. <br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SH01M?1 MAY HAVE BEEN REDUCED BV PAID CLAIMS. <br />IN9R TYPE OF INSURANCE DDL UBR POLICY NUMBER MMIU Y F NOD V ExP LIMITS <br />/.? GENERAL DABILITY ? 6806825L007 12/1/2010 12/1/2011 ACH <br />E <br />OC <br />CUR <br />RENCE E <br />1,000,000 <br /> COMMERCIAL GENERAL LIABILITY Scheduled AI Endt R? <br />p <br />? <br />T <br />REM <br />E <br />ocdE <br />e __ <br /> <br />#CGD3820907 P <br />IS <br />S Ee <br />rr <br />nca) s l ,000.000 <br /> ?GLAIMS-MADE ?? OCCI/R f <br />Pr <br />i <br />l S <br />i MED EJ(P An <br />yOne person) DD <br />E tD <br /> <br />? <br />Primary/NOn-COfIVIbUtO1y- _ <br />o <br />ess <br />ona <br />erv <br />ces <br />perfORTBd by iFle In SUred _ <br />PERSONAL 8 ADV INJURY <br />. <br />E 1,000,000 <br /> ? WalVgr Of $UbrOgatiOn __ afe EXCIUded GENERAL AGGREGATE E 2.000,00 <br /> GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS -COMP/OP AGG E 2,000,000 <br /> POLICY ? PRO ? LOC E <br />A AUT OMOBILE LIABILITY <br />? BA6819L639 12/1/20'10 12/1/201'1 C INED NGLE LI <br /> Ea a=?tlene s <br />J <br />000 000 <br /> ? ANY AUTO Designated Insured N _ <br />.? <br /> Endt #CA20480299 BODILY I <br />JVRY (Per pereOn) E <br /> ALL OWNED <br />Auros SCHEDULED <br />AOros <br />Blanket Waiver of BODILY INJURY (Peramitlerrt <br />) <br />E <br /> ? HIRED AUTOS ? A?IfTOSWNED Subrogation #CAT3400808 PR PERTY DAMAGE <br />Par eccitle^0 - <br />E -_ <br /> <br /> E <br />A ? UMBRELLA LIAR ? OCCUR CUP7915Y817 12/1/2010 12/1/2011 EACH OCCURRENCE E <br />400000 <br /> EXCE <br />SS L <br />IAB CLAIMS-MADE ExGudes Professfonal AGGREGATE _ <br />E <br /> <br />? _ <br />T <br />? <br />DED L? RETENTION EO <br />Liability 4 000 UQ0 <br />- <br />E <br /> E <br /> E <br /> WORMERS COMPENSATION N.C STATU- OTH- <br /> AND EMPLOYERS' LIABILITY Y / N TORY LI IT Eft _ _ ___ <br /> ANY PROPRIETOR/PARTNER/EXECUTI V E <br />OFFICER/MEMBER EXCLUDEDT ? <br />N / A <br />E.L. EACH ACCIDENr <br />E <br /> (Mandatory In NN) <br />Ir <br />ea <br />tleecriUe untler E-L. DISEASE - Eo. EMPLOYEE <br />- 5 <br /> y <br />, <br />DESGRIPTION OF OPERATIONS Ealaw EL. DISEASE -POLICY LIMIT E <br />B Professional Liability V15PR3100301 12/1/2070 12/1/2011 $1,000,000 Per Claim <br /> Claims-Made $2,000,000 Aggregate <br />DESCRIPTION OF OPERATIONS /LOCATIONS /VEHICLES (Attacn ACORD 101, AaEltlonal Remarks SU,etlule, M moos apace le reQulredl <br />Certificate Hokfer is an Additional Insured with respeG to Generel Liability and Automobile Liability but only when required by written contract with <br />Named Insured prior to an occurrence as per Endorsement(s) noted above. General Liability tnGUdes Separation of Insureds and Contractual <br />Liability per limitations in the Liability Coverage form #CG00011001. Coverage is subject to all policy terms, conditions, limitations and exGusions. <br />30 Day Notice of Cancellation/1 O Day Notice for Non-Payment of premium. <br />C 1 ICA OLDER CANCELLATION <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />City of Santa Ana, Its Officers and Employees THE EXPIRATION DATE THEREOF, NOTICE NRLL BE DELIVERED IN <br />P.O. BOX '19$$ ACCORDANCE WITH THE POLICY PROVISIONS. <br />Santa Ana CA 92702 APP <br />R <br />O <br />V ED <br />" <br />` <br />?; <br />j <br />U ?^`-` ?rHOPoZED REPRESENTATVE <br />V ivl <br />//) <br />RECEIVIED <br />/ <br />? <br />? <br />? <br />? <br />? <br />/ <br />// <br />C r <br />/jam ? <br />`?? Ti°? <br />'?it <br />?? <br />?==- <br />?, <br />? <br />-? <br />__-.? <br />? <br />(/ <br />-- <br />-.- ? <br />- (AVC) Alicia K. 1 ram <br />- - q?s--t-a-,,ur .?.,1 e ?njCedv -- ®'t989-2010 ACORD CORPORATION- All rights reserved. <br />?B 25 (20'10/0 + -TITe A?Of?d tr}arilg la?rm logo are registered marks of ACORD <br />----. _ - - <br />CEFT NC.: e09e TOe i?ici ?'YaiJC 12 /2010 1:13:50 PM Pages 1 OE 5