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A� " CERTIFICATE OF LIABILITY INSURANCE DATE(MWODNYYY) <br />! /2 11 <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 terms and conditions of the policy, certain policies may require an endorsement A statement on this certificate does not confer rights to the <br />cert fee holder in lieu of such endorsements). <br />PRODUCER Insurance Office of America CONTACT NAME: <br />130 Yantis, Suite 250 PHONE • 949-297-5962(A/C, No: 949-297-5960 <br />Aliso Viejo, CA 92656 <br />NAIC # <br />www.ioausa.com -CA -License #,OE67768 INWRERA: RLIlnsurangeCompany,_ <br />INSURED jNSUKR"azley Insurance Company <br />Johnson -Frank 81 Associates, Inc. <br />5150 E. Hunter Avenue INSURERC: <br />Anaheim CA 92807 INSURER D: <br />INSURER E : <br />CAVFRAr;FSt CCDTICIr`ATC L111aICGo. <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 INSURANCE <br />ADDL <br />SUB <br />WVQPOLICY <br />NUMBER <br />MMIDDY <br />POUCY FJ(P <br />LIMITS <br />A <br />GENERAL <br />✓ <br />LIABILITY <br />COMMERCIAL GENERAL LIABILITY <br />F7/ <br />V ✓ <br />'�, <br />PSB0001301 <br />Scheduled Al Endt <br />#PPB3130610 <br />12/1/2011 <br />12/1/2012 <br />EACH <br />$ 1,000,000 <br />�OCCURRENCE- <br />PREMISES EatN I IzU ce <br />s 1,000,000 <br />CLAIMS -MADE OCCUR <br />Primany/NOn-Contributory_ <br />Waiver of Subrogation <br />I <br />Professional Services <br />performed by the insured <br />are Excluded <br />MED EXP (Any one person) <br />S 10,000 <br />✓_ <br />✓ <br />PERSONAL BADVINJURY <br />$ 1,000,000 <br />GENERAL AGGREGATE <br />$ 2,000,000 <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />POLICY ✓ JECTPRO- ✓ LOC <br />PRODUCTS-COMP/OPAGG <br />$ 2,000.000 <br />S <br />A <br />AUTOMOBILE <br />✓ <br />✓ <br />✓ <br />✓ <br />LIABILITY <br />ANY AUTO <br />ALL OWNED SCHEDULED <br />AUTOS AUTOS <br />HIREDAUTOS ✓ AUTO-SWNED <br />Primary/Non-Contributory <br />Waiver of Subr ation <br />✓ <br />✓ <br />PSA0001078 <br />Designated Insured <br />Endt #CA20480299 <br />Primary/Non-Contributory <br />and Blanket Waiver of <br />Subrogation included in <br />Coverage Form #PPA3000311 <br />12/1/2011 <br />12/1/2012 <br />%=SINGLE LIMIT <br />$ 100000 <br />BODILY INJURY (Per person) <br />$ <br />BODILY INJURY (Per accident) <br />S <br />PROP �R^DAMAGE <br />$ <br />$ <br />$ <br />A <br />UMBRELLA LIAB <br />EXCESS LIAB <br />`/ <br />OCCUR <br />CLAIMS -MADE <br />PSE0001230 <br />Excludes Professional <br />Liability <br />12/1/2011 <br />12/1/2012 <br />EACH OCCURRENCE <br />$4,000,000 <br />AGGREGATE <br />$ 4,000,000 <br />DED RETENTIONS <br />$ <br />$ <br />S <br />B <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY Y/ N <br />ANY PROPRIETOPJPARTNERJEXECUnVE <br />OFFICER/MEMBER EXCLUDED? NIA <br />(Mandatory In <br />If yes, describe under <br />undnder <br />DESCRIPTION OF OPERATIONS helow <br />Professional Liability <br />Claims -Made <br />V15PR3110401 <br />12/1/2011 <br />12/1/2012 <br />WC STATU- pTH <br />TOR, LIMITS ER <br />E.L. EACH ACCIDENT <br />$ <br />E.L. DISEASE - EA EMPLOYEE <br />$ <br />E.L. DISEASE - POLICY LIMIT $ <br />$1,000,000 Per Claim <br />$2,000,000 Aggregate <br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks schedule, IF more space Is required) <br />Certificate Holder is an Additional Insured with respect to General Liability and Automobile Liability but only when required by written contract with <br />the Insured prior to an occurrence as per Endorsement(s) noted above. General Liability includes Separation of Insureds and Contractual Liability <br />per limitations in the BusinessOwners Coverage form. Coverage is subject to all policy terms, conditions, limitations and exclusions. 30 Day Notice <br />of Cancellation/10 Day Notice for Non -Payment of premium. <br />CERTIFICATE HOLDER <br />CANCELLATION <br />CIOof Santa Ana, Its Officers and Employees <br />P.. Box 1988 <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 />Santa Ana CA 92702 <br />AUTHORIZED REPRESENTATIVE <br />(AVC) Alicia K. I ram <br />v lava-cvly /4%.UKU VUKI'UKA 1IUN. All rights reserved. <br />ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD <br />CERT NO.: 11750526 Teresa Frank 11/30/2011 4:29:07 PM Page 1 of 4 <br />