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ACOROF CERTIFICATE OF LIABILITY INSURANCE <br />i._.-�" <br />DATE(MMIDD/YYYY) <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 />certificate holder in lieu of such endorsement(s). <br />PRODUCER Insurance Office of America <br />130 Vantis, Suite 250 <br />Aliso Viejo, CA 92656 <br />www.ioausa.com CA License#OE67768 <br />CONTACT NAME: <br />PHONE A/C No): 949-297-5960 <br />E-MAIL ADDRESS: <br />INSURERS AFFORDING COVERAGE <br />NAIC # <br />INSURER A: R I Insurance Company <br />INSURED <br />Johnson -Frank & Associates, Inc. <br />5150 E. Hunter Avenue <br />Anaheim CA 92807 <br />INSURER B: Beazley Insurance Company,Inc.4 <br />INSURERC: <br />INSURERD: <br />INSURER E : <br />INSURER F : <br />COVERAGES CERTIFICATE NUMBER: 14799125 REVISION NUMBER: <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 />SUBR <br />POLICY NUMBER <br />POLICY EFF <br />MM/DD/YYYY <br />POLICY EXP <br />MM/DD/YYYY <br />LIMITS <br />A <br />GENERAL LIABILITY <br />V <br />PSB0001301 <br />12/1/2012 <br />12/1/2013 <br />EACH OCCURRENCE <br />$ 1,000,000 <br />V COMMERCIAL GENERAL LIABILITY <br />CLAIMS -MADE �✓ OCCUR <br />Scheduled Al Endt <br />#PP63130610 <br />Professional Services <br />DAMAGE TO RENTED <br />PREMISES Ea occurrence) <br />$ 1,000,000 <br />ME EXP (Any one person) <br />_ <br />$ 10,000 <br />PERSONAL & ADV INJURY <br />$ 1,000,000 <br />V Primary/Non-Contributory <br />performed by the Insured <br />✓ <br />Waiver of Subrogation <br />GENERAL AGGREGATE <br />$ 2,000,000 <br />are Excluded <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />PRODUCTS -COMP/OP AGG <br />$ 2,000,000 <br />1-7 POLICY �/ PRO `/ LOC <br />$ <br />A <br />AUTOMOBILE <br />LIABILITY <br />ANY AUTO <br />ALL OWNED SCHEDULED <br />AUTOS AUTOS <br />NON -OWNED HIRED AUTOS E Aand <br />HIRED AUTOS AUTOS <br />Primary/Non-Contributory <br />Waiver of Subro ation <br />✓ <br />✓ <br />PSA0001078 <br />Designated Insured <br />Endt #CA20480299 <br />Primary/Non-Contributory <br />Blanket Waiver of <br />Subrogation included <br />Coverage Form #PPA3000311 <br />12/1/2012 <br />- <br />12/1/2013 <br />EaacB,ICIdeDnt)SINGLELIMIT <br />$ 1,000,000 <br />BODILY INJURY (Per person) <br />$ <br />BODILY INJURY Per accident <br />( ) <br />$ <br />✓ <br />PROPERTY DAMAGE <br />Per accident <br />$ <br />✓ <br />✓ <br />$ <br />$ <br />A <br />UMBRELLA LIAB <br />✓ <br />OCCUR <br />PSE0001230 <br />12/1/2012 <br />12/1/2013 <br />EACH OCCURRENCE <br />$ 4,000,000 <br />AGGREGATE <br />$ 4,000,000 <br />✓ <br />EXCESS LIAB <br />CLAIMS -MADE <br />Excludes Professional <br />DED RETENTION $ <br />Liability <br />�( , <br />'1SaUIo11F1 � <br />aaq 1 <br />j", . , " V <br />�in1v 7 <br />$ <br />$ <br />$ <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY Y/ N <br />ANY PROPRIETOR/PARTNER/EXECUTIVE <br />OFFICER/MEMBER EXCLUDED? ❑ <br />(Mandatory in NH) <br />If yes, describe under <br />N / A <br />_ / <br />0 1T Sd <br />/ <br />(A A ! 1 <br />�� <br />( <br />WC STATU- O7H <br />TORY LIMITS ER <br />E.L. EACH ACCIDENT <br />$ <br />E.L. DISEASE - EA EMPLOYEE <br />$ <br />E.L. DISEASE - POLICY LIMIT 1 <br />$ <br />DESCRIPTION OF OPERATIONS below <br />W�0a . <br />B <br />Professional Liability <br />Claims -Made <br />V15PR3120501 <br />12/1/2012 <br />12/1/2013 <br />$1,000,000 Per Claim <br />$2,000,000 Aggregate <br />DESCRIPTION OF OPERATIONS /LOCATIONS /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 Business Owners' 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 />City of Santa Ana, its officers and employees <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />P.O. Box 1988 <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />Santa Ana CA 92702 <br />AUTHORIZED REPRESENTATIVE <br />AVC Alicia K. I ram <br />©1988-2010 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD <br />CERT NO.: 14799125 Teresa Frank 11/28/2012 4:14:30 PM Page 1 of 4 <br />