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Policy Number: Date Entered: 10/6/2010 '`' ° CERTIFICATE OF LIABILITY INSURANCE DATE 0 1 IDDI 1 1 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(les) must 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). PRODUCER Adams Avenue Insurance A enc NAME: g y License # 0756665 PHONE (877) 250-8397 Fe r Ne. (866) 832--4186 (AIG, NQ, Ell), 9114 d # E MAIL @AdamsAveIns.com AODR S A ams Ave, 144 PRODUCER M RIO M: CUSTO Huntington Beach, CA 92646 INSURER(S) AFFORDING COVERAGE NAICB INSURED G INSURERA: Sequoia Insurance Company A WRJ- T LLC, dba 1Essergy Consulting INSURERB:United States Liability Insurance Co Jill Dominguez INSURER C : 235 E Broadway #520 h INSURER D : Long Beac , CA 90802 INSURER E INSURER F COVERAGES CERTIFICATE NUMBER: 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 6Y TH POUIOES RI EIN IS E 7 T ALL THE AN N ITIONS OF H POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS ILTR TYPE OF INSURANCE ADDL SUER POLICY NUMBER POLICY EFF (MMI()D)YYYYI POLICY EXP IMWDDIYYYYI . LIMI S GENERAL LIABILITY EACHOCCURRENCE S1.0001000 A I COMMERCIAL GENERAL LIABILITY X SBP212192-3 9/1/2010 9/1 011 PREMISES Ea«axrence S 300 000 CLAIMS-MADE I>< OCCUR o t+ L MED EXP An one erson $ 10,000 T PERSONALSADVINJURY S Included ?p GENERAL AGGREGATE $ 2 000 000 = La GEN'LAGGREGATE LIMIT APPLIES PER: - - PRODUCTS-COMPr'OP AGG $2 000 000 1 POLICY PR0. LOC 1 F $ A AUT OMOBILE LIABILITY ANYAUTO X Assistant t At 0 IY COMBINED SINGLE LIMIT (Ea acGdenq $1,000,000 ALL OWNED AUTOS '12 BODILY INJURY (Per person) S SCHEDULEDAUTOS " BODI LY ]NJ URY(Per accident S PROPERTY DAMAGE - $ HIREDAUTOS SBP21219201 9/1/2010 9/1/2011 (Peraccidem) NON-OWNEDAtrrOS SBP21219201 9/1/2010 9/1/2011 - UMBRELLA LIAR F I OCCUR EACHOCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ S WORKERS COMPENSATION WC STATU- OTH- ANOEMPLOYERS' LIABILITY YIN ANY PROPRIETORIPARTNERIEXECUTIVE OFFICER/MEMBER EXCLUDED? NIA E.L. EACH ACCIDENT S (Mandatory In NH) Ilyes, desenbe under E.L DISEASE- EA IIIr1PLOYEE $ DESCRIPTION OF OPERATIONS be?a>r E.L DISEASE-POLICY LIMIT 5 B Professional SP1018037 7/13/2010 7/13/2011 Each Claim 1,000,000 Liability Aggregate 1,000,000 DESCRIPTION OF OPERATIONSI LOCATIONS I VEHICLES (Attach ACORO 101, Additional Remarks Schedule, If more space Is required) Certificate holder is additional insured, see attached CERTIFICATE HOLDER CANCELLATION City of Santa Ana SHOULD ANY F THE ABOVE DESCRIBED POLIC IES arz A EL ED 13EFORE 20 Civic Center Plaza THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Santa Ana, CA 92702 AUTHORIZED REPRESENTATIVE - + QffX?-re_ v 7988.2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009109) The ACORD name and logo are registered marks of ACORD ProducedusingForms BassPlussoftware,www.FormsBoss.conr nipressivePuNisHng800-2OB-Sg77