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ACC>R0 CERTIFICATE OF LIABILITY INSURANCE <br />`..• •'' <br />DATE(MM/DD/YYYY) <br />11 /30/2017 <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 polfcy(ies) must have ADDITIONAL INSURED provisions or be endorsed. <br />If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on <br />this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). <br />PRODUCER IOA Insurance Services <br />130 Yantis, Suite 250 <br />Aliso Viejo, CA 92656 <br />ACT <br />NAME: Betty Tran <br />A/C No Ex : 949-297-5962 ac No): 949-297-5960 <br />E-MAIL <br />ADDRESS: betty.tran@loausa.com <br />INSURERS AFFORDING COVERAGE <br />NAIC # <br />INSURERA: RLI Insurance Company <br />13056 <br />www.ioausa.com CA License #OE67768 <br />INSURED <br />Johnson -Frank & Associates, Inc. <br />5150 E. Hunter Avenue <br />INSURER B : <br />INSURERC: <br />INSURERR; <br />Anaheim CA 92807 <br />INSURER $; <br />RE F. <br />COVERAGES CERTIFICATE NUMBER: 39 4082 REVISION NUMBER, <br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED 7O THE INSURED NAMED ABOVE FOR THE POLICY PERIOD <br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />ILTR <br />TYPE OF INSURANCE <br />D <br />R <br />O UM R <br />M I <br />$ <br />LIMITS <br />A <br />✓ <br />COMCLAIMS-MADEERA�LIOCGUR <br />� <br />Prim/NonCon <br />✓ <br />✓ <br />Sohed0u01$dAlndt <br />#PP63130212 <br />Professional Services <br />12/1/2Q17 <br />12/1/2018 <br />EACH OCCURRENCE <br />$10000 Q. <br />SMIS cENCfi <br />TED <br />sAO cares <br />s 1,IQ0,000 <br />✓ <br />MED EXP (Anyone person) <br />$10 000 <br />Wvr of Subr <br />PERSONAL S AOV INJURY <br />$1 t000,000 <br />✓ <br />performed by the Insured <br />AGGREGATE LIMIT APPLIES PER: <br />✓❑ [ - ] LOG <br />POLICY JE� <br />GENERALAGGREGATI? <br />$2,00000 <br />GEN'L <br />are Excluded <br />PRODUCTS •COMP/OP AGG <br />$R.000,000 <br />$ <br />OTHER: <br />A <br />AUTOMOBILE <br />✓ <br />✓ <br />LIABILITY <br />ANY AUTO <br />OWNED SCH DULED <br />HIRED AUTOS ONLY A�1TS <br />AUTOS ONLY ✓ AUTO ONLY <br />✓ <br />PSA0001078--- -- <br />Designated Insured n <br />g rd' dt <br />#CA20481013; Prim/NonCon <br />and Slkt Wvr of Subr <br />IICIUCf$d On pg 2 Of Form <br />-12/1/2017 <br />-12/1/2018 <br />1 . sectant' i .,.I . ..... <br />$1.9001000 <br />BODILY INJURY (per person) <br />$ <br />BODILY INJURY (Par accident) <br />$ <br />MAGE <br />Per n tl lit A <br />$ <br />$ <br />✓ <br />Prim/NonCon ✓ W r of Svbr.. <br />I#PPA300Q.31,a, <br />A <br />✓ <br />UMBRELLA LIAB <br />EXCESS LIAB <br />✓ <br />OCCUR <br />CLAIMS -MADE <br />PSE0001230 <br />Excludes Professional <br />Liability <br />12/1/2017 <br />12/1/2018 <br />EACH OCCURRENCE <br />$4 QQQ 000 <br />AGGREGATE <br />$ 4 QOQ 000 <br />DED I I RETENTION s <br />A <br />WORKERS COMPENSATION Y N <br />AND EMPLOYERS' LIABILITY <br />ANYPROPRIETOR PARTNER/ XECUTIVE <br />OFFICER/MEMBEREXCLUR 7 Y <br />(Mandatory in NH) <br />If yes, describe under <br />DESCRIPTION OF OPERArI -. S below <br />N/A <br />✓ <br />Waiver of <br />Endt #WC0403060484 <br />1'/1/ 017 <br />1072618 <br />✓ TUT <br />E.L. EACH ACCIDENT <br />$10 Qt Q <br />E.L. DISEASE � EA EMPLOYEE <br />_ <br />$ 0 <br />DiSEA E • POLICY IMIT <br />$1 . Q <br />A <br />Professional Liability <br />P O 4 <br />12/1 201 <br />12/1 -1 <br />2,000,0 0 Eacha m <br />Claims -Made <br />$2,000,000 Aggregate <br />DESCRIPTION OF OPERATIONS / LOCATIONS /VEHICLES (ACORD 101, Addltional Remarks Schedule, maybe attached Ir more apace Is required) <br />Certificate Holder is an Additional Insured with respect to General Liability (CL) and Automobile Liability but only when required byy written contract <br />with the Insured prior to an occurrence as per Endorsements noted above. GL Includes Separation of Insureds and Contractual Liabllity per limitations <br />in the BusinessOwners' Coverage form. A Workers' Compensation Waiver of Subrogation as noted above is included for the arson or organization named <br />In the Schedule that are parties to a contract r$quiring this Endorsement, provided that contract is executed before the loss. Coverage subject to all <br />policy terms, conditions, limitations and exclusions. 30 Day Notice of Canool/10 bays for Non -Payment In accor!snf with policy provisions. <br />REVIEWED BY:4��AqEUNiCE HEREDiA (PG <br />City of Santa Ana, its officers and employees <br />PO Box 1988 M-36 <br />Santa Ana CA 92702 <br />:SHOULD ANY OF THE ABOVE DESCRIBED POLICIES 09 CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />ACCORDANCE WITH THE POLICY PROVISIONS, <br />AUTHORIZED REPRESENTATIVE <br />(AVC) Alicia K. loram � <br />. All rights reserved. <br />ACORD 25 (2016/03) <br />The ACORD name and logo are registered marks of ACORD <br />39024082 1 12/17-18 GL/AUTO/EXCESS/WC/PL I Donna Esquivel 1 11/30/2011 100101 AM (PST) I Page 1 of 5 <br />