|
A C>R �
<br />CERTIFICATE OF LIABILITY INSURANCE
<br />DATE IMMIDD/YYYY)
<br />�,.
<br />12/1/201s
<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 ICIA insurance "..'er0ces,
<br />N
<br />NAAMMEE:: BettyTian.
<br />130 Vantls, Suite 250
<br />Al so Viejo, CA 92656
<br />PHONE 949-297-5962 FAX No 949-297-5960
<br />F-MAIL
<br />ADDRESS: bett .tran ioausa,com
<br />INSURER(S) AFFORDING COVERAGE
<br />NAIL #
<br />INSURER A : RLI Insurance Company
<br />13056
<br />www,ioausa.com CA License #DE67768
<br />INSURED
<br />Johnson -Frank & Associates„ Inc.
<br />INSURER B :
<br />5150 E, Hunter Avenue
<br />INSURER C
<br />ENSURER D
<br />Anaheim CA 92807
<br />INSURER, E
<br />INSURER F
<br />COVERAGES CERTIFICATE NIJMRFR- 97e709nz PI=VICInIM h1IIMRFR-
<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 />ADOL
<br />sUBtk........
<br />POLICY NUMBER
<br />POLICY EFF
<br />MMIDDIYYYY.IMM/DD/YYYYJ
<br />POLICY EXP
<br />LIMITS
<br />A
<br />wr
<br />COMMERCIAL GENERALLIABIUTY
<br />CLAWS -MADE
<br />Prim/NonCon
<br />V✓
<br />M/
<br />PSB0001301.
<br />AI Endt
<br />i#PPS3130212
<br />Professional Services
<br />12/1./2.015
<br />121112016
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />DAMAGE TO RENTED
<br />PREMISES Ea occurmence
<br />$ 1,000,000
<br />✓
<br />MEn EXP (Any one person)
<br />$ 10,000
<br />✓
<br />Wvrof Subr
<br />PERSONAL BADVINJURY
<br />$ 1,000,000
<br />performed by the Insured
<br />GENERAL AGGREGATE
<br />$.. 2.000,000
<br />GEN`L
<br />AGGREGATE LIMIT APPLIES PER:
<br />POLICY 0 PICOT- [,/] LOC
<br />are Excluded
<br />PRODUCTS - COdP/OPAGG
<br />$ 2,000,.000
<br />OTHER:
<br />A
<br />AUTOMOBILE
<br />/
<br />F
<br />LIABILITY
<br />ANY AUTO
<br />ALL OWNED SCHEDULED
<br />AUTOS AUTOS
<br />NON -OWNED
<br />AUTOS
<br />'IRED AUTOS r,/
<br />d"
<br />✓
<br />PSA0001.078
<br />Designated Insured Endt
<br />#CA2048101.3; Prim/NonCan
<br />and Blkt Wvr of Subr
<br />included on pg 2 of Form
<br />12/1/2015
<br />12/1/2016
<br />OOMBINEO SINGLE LIMIT
<br />Eaaccidea
<br />$ 1,000,000
<br />BODILY INJURY Per person)
<br />I p i
<br />$
<br />BODILY INJURY Peraccidonl)
<br />I
<br />PROPERTY DAMAGE
<br />Per accident
<br />$
<br />$
<br />✓
<br />rim/NonCon Wvr of Subr
<br />#PPA3000313
<br />A
<br />UMBRELLA LIAB
<br />OCCUR
<br />PSE0001230
<br />1211/2015
<br />12/1/201'6
<br />EACH OCCURRENCE
<br />$ 4,000,000
<br />EXCESS LIAR
<br />H
<br />CLAIMS-IrIADE':
<br />Excludes Professional
<br />Liability
<br />AGGREGATE
<br />$ 4,000,000
<br />OEP RETENTION;i
<br />$
<br />A
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY YIN
<br />ANY PROPRIETORfPARTNER/EA=CUTIVE
<br />OFFICERIMFMSER EXCLUDED ®N
<br />(Mandatory in NH)
<br />If yes, desc6ba, under
<br />DESCRIPTION CIE OPERATIONS below
<br />d A
<br />7
<br />PSWO002298
<br />Waiver of Subrogation
<br />Endt #WC0403060484
<br />1211/2015
<br />12/12016
<br />I
<br />� saFAPTUTE rEaTPH-
<br />E.L. EACH ACCIDENT
<br />$ 1,000,000
<br />E.L. DISEASE.- FA EMPLOYEd
<br />$ 1,000,400
<br />E.L. DISEASE .. POLICY LIMIT
<br />li $ 1 ,000,000
<br />A
<br />Professional Liability
<br />RDP0022644
<br />12/1/2015
<br />12/1/2016
<br />$2,000,000 Each Claim
<br />Claims -Made
<br />$2,000,000 Aggregate
<br />DESCRIPTION OF OPERATONS d LOCATIONS f VEHICLES (ACORD i Ot, Additional. Remarks Schedule, may he attached 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 pasties to a contract requiring this Endorsement, provided that contra, t is ex uked before the Toss. Coverage subject to all
<br />policy terms, conditions, limitations and exclusions. 30 Day Notice of Cancel/10 Days for No t' Payme, in accordance with policy provisions.
<br />m �� ;
<br />I !' EE IED Lffi"Y/ f" t1I II( ,..I.,it I"I L11^A wl 111- �...
<br />CERTIFICATE HOLDER CANCELLATION
<br />City of Santa Ana, its officers and employees
<br />PO Box 1988
<br />Santa Ana CA 92702
<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 />AUTHORIZED REPRESENTATIVE 7
<br />(AVC) Alicia. K. lgram
<br />@ 1988-2014 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2014/01) The ACORD name and logo are registered miarks of ACORD
<br />2,,74r 22;01, 1 l /1ti is /AJT0/EK s /WF/1 cw_ ;a'r: 1 12/1/20t,, 121:3s 01 PM ?sa i _a s t of i
<br />
|