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A� " CERTIFICATE OF LIABILITY INSURANCE
<br />DATE(mmloomr )
<br />2/3/2013
<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 IOA Insurance Services
<br />130 Vantis, Suite 250
<br />Aliso Viejo, CA 926567-5960
<br />CONTACT NAME:
<br />PHONE AIC No:
<br />E-MAIL ADDRESS,
<br />INSURERS AFFORDING COVERAGE
<br />NAIC#
<br />INSURERA: RLI Insurance company
<br />13056
<br />www.ioausa.eom CA License#OE67768
<br />NJohnson-Frank&Associates, Inc.
<br />NSURERB: BP,F�](Py Insurance Company. Inc.
<br />37540
<br />5150 E. Hunter Avenue
<br />INSURER C:
<br />INSURER D:
<br />Anaheim CA 92807
<br />INSURER E:
<br />r•
<br />INSURER F:
<br />COVERAGES CERTIFICATE NUMBER: 18492390 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 />INSRR
<br />TYPE OF INSURANCE
<br />ADDL
<br />SUBR
<br />POLICY NUMBER
<br />MMIDOY�
<br />MMIDOV�
<br />LIMITS
<br />A
<br />GENERAL LIABILITY
<br />,/
<br />V
<br />PSB0001301
<br />12/1/2013
<br />12/1/2014
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />✓ COMMERCIAL GENERAL LIABILITY
<br />CLAIM&MADE OCCUR
<br />Scheduled Al Endt
<br />#PPB3130212
<br />Professional Services
<br />PREMSESOEeoocurrence
<br />$ 1,000,000
<br />MED EXP(Any one person)
<br />$ 10,000
<br />PERSONAL&ADV INJURY
<br />$ 1,000,000
<br />✓ Primary/Non-Contributory
<br />performed by the Insured
<br />✓
<br />Waiver of Subrogation
<br />are Excluded
<br />GENERAL AGGREGATE
<br />$ 2,000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />PRODUCTS - COMP/OP AGG
<br />$ 21000,000
<br />POLICY ✓ EC JT ✓ I LOC
<br />$
<br />A
<br />AUTOMOBILE
<br />LIABILITY
<br />ANY AUTO
<br />OS SCHEDULED
<br />AUTOS AUTOS
<br />✓
<br />✓
<br />PSA0001078
<br />Designated Insured
<br />Endt mary/N n-Cont3
<br />Primary/Non-Contributory
<br />12/1/2013
<br />12/1/2014
<br />COBINEDtSINGLE LIMIT
<br />$ 1,000,000
<br />BODILY INJURY Per person)
<br />( P IAU
<br />$
<br />BODILY INJURY (Per accidenQ
<br />$
<br />Peracddent AMAGE
<br />$
<br />IV//
<br />HIREDAUTOS ✓ AUTOSWNED
<br />NON-OPrimary/Non-Contributory
<br />and Blanket Waiver of
<br />Subrogation included in
<br />Form #PPA3000313Waiver
<br />$Coverage
<br />$
<br />of Subro anon
<br />A
<br />UMBRELLA LIAR
<br />OCCUR
<br />PSE0001230
<br />12/1/2013
<br />12/1/2014
<br />EACH OCCURRENCE
<br />$ 4,000,000
<br />✓
<br />AGGREGATE
<br />$ 4,000,000
<br />EXCESS LIAR
<br />CLAIMS -MADE
<br />Excludes Professional
<br />DED RETENTION$
<br />Liability
<br />$
<br />A
<br />WORKERS COMPENSATION
<br />ANO EMPLOYERS' LIABILITY
<br />ANY PROPRIETORIPARTNEWEXECUTIVE Y/N
<br />OFFICER/MEMSER EXCLUDED? ❑Y
<br />(Mandatory In NH)
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />NIA
<br />✓
<br />PSWOOO2298
<br />Waiver of Subrogation
<br />Endt#WC0403060484
<br />12/1/2013
<br />12/1/2014
<br />-
<br />WCSTATU- JOIN
<br />TORY LIMITS
<br />E.L. EACH ACCIDENT
<br />$ 1000000
<br />E. L. DISEASE - EA EMPLOYEE
<br />$ 1000000
<br />E.L. DISEASE -POLICY LIMIT
<br />$ 1,000,000
<br />B
<br />Professional Liability
<br />V15PR3130601
<br />12/1/2013
<br />12/1/2014
<br />$1,000,000 Per Claim
<br />Claims -Made
<br />$2,000,000 Aggregate
<br />DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach AC ORD 101, Additional Remarks Schedule, if more space Is required)
<br />Certificate Holder is an Additional Insured with respect to General Liability (GL) and Automobile Liability but only when required by written contract
<br />with the Insured prior to an occurrence as per Endorsements noted above. GL includes Separation of Insureds and Contractual Liability per limitations
<br />in the BusinessOwners' Coverage form. A Workers' Compensation Waiver of Subrogation as noted above is included for the person or organization named
<br />in the Schedule that are parties to a Contract requiring this Endorsement, provided that contract is executed before the loss. Coverage subject to all
<br />Dolicy terms conditions limitations and exclusions. 30 Day Notice of Cancel/10 Davs for Non -Pa ment in accordance with Policy provisions.
<br />CERTIFICATE HOLDER
<br />CANCELLATION
<br />y �p � ,ro P(
<br />City of Santa Ana, Its Officers an)4Pflrld� &1iD " r,j
<br />P.O. Box 1988
<br />P$I'cfOULD 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
<br />tt Speed
<br />Laura Sfiy
<br />REPRESENTATIVE
<br />Assistant City Attorne
<br />(c�d
<br />AVC Alicia K. Igram
<br />©1988.2010 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD
<br />rare NO.: 30992390 Teresa Frank 12/3/2013 11:99:19 AM Page 1 of 5
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