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ACOR T aDATE <br />CERTIFICATE OF LIABILITY INSURANCE <br />(MM/DDIYYYY) <br />2/6/2012 <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 <br />Hayward Tilton & Rolapp Insurance Associates, <br />CA Dept. of Ins. Lic. #0614365 <br />888 S. Disneyland Dr., Ste 400 <br />Anaheim CA 92802-1846 <br />CONTACT <br />NAME: Dona Delight <br />PHONE (714)905-1923 FAX.(714)905-1910 <br />E-MAIL .donad@htrinsure.com <br />INSURERS AFFORDING COVERAGE NAIC # <br />INSURERA:Travelers Indemnity Co of CT 25682 <br />INSURED <br />Mullen & Associates, Inc.N-211-159' QQ� <br />1200 N. Jefferson Street <br />Suite D <br />Anaheim CA 92807 <br />INSURERB:Preferred Employers Ins Co <br />INSURERC:U S Specialty Ins Co 9599 <br />INSURER D: <br />INSURER E: <br />1 INSURER F: <br />COVERAGES CERTIFICATE NUMBER:201la gl-auto-E&O-WC 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 />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />SUBR <br />POLICY NUMBER <br />POLICY EFF <br />MMIDDIYYY <br />POLICY EXP <br />MM/DD/YYYY <br />LIMITS <br />GENERAL LIABILITY <br />Public Works Agency M-21 <br />EACH OCCURRENCE $ 1,000,000 <br />MERCIAL GENERAL LIABILITY <br />7DDL <br />DAMAGE TO <br />PREMISES Ea otccur ence $ 300,000 <br />ACLAIMS-MADE <br />� OCCUR <br />rk <br />6804413L748 <br />/24/2011 <br />/24/2012 <br />MED EXP (Any one person) $ 5,000 <br />PERSONAL & ADV INJURY $ 1,000,000 <br />GENERAL AGGREGATE $ 2,000,000 <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />PRODUCTS - COMP/OP AGG $ 2,000,000 <br />$ <br />X1 POLICY PRO LOC <br />AUTOMOBILE <br />LIABILITY <br />COMBINED SINGLE LIMIT <br />Ea accident 1 000 000 <br />BODILY INJURY (Per person) S <br />A <br />ANY AUTO <br />ALL OWNED SCHEDULED <br />AUTOS AUTOS <br />804413L748 <br />/24/2011 <br />/24/2012 <br />BODILY INJURY (Per accident) $ <br />Pe PEaccRTY DAMAGE $ <br />X <br />HIRED AUTOS X NON -OWNED <br />AUTOS <br />Policy covers non -owned <br />$ <br />fired auto only. <br />UMBRELLA LIAB <br />OCCUR <br />EACH OCCURRENCE $ <br />AGGREGATE $ <br />EXCESS LIAB <br />CLAIMS -MADE <br />DED I I RETENTION $ <br />$ <br />B <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY Y I N <br />ANY PROPRIETOR/PARTNER/EXECUTIVE <br />X WC STATU- OTH- <br />E.L. EACH ACCIDENT $ 1 000 000 <br />OFFICERIMEMBER EXCLUDED? <br />(Mandatory in NH) <br />"/A <br />133245 5 <br />/4/2011 <br />/4/2012 <br />E.L. DISEASE - EA EMPLOYEE $ 1,000,000 <br />Ifyes, describe under <br />DESCRIPTION OF OPERATIONS below <br />133245 6 <br />/4/2012 <br />/4/2013 <br />E.L. DISEASE - POLICY LIMIT $ 1,000,000 <br />C <br />Professional Liability <br />USS1222541 <br />/4/2012 <br />/4/2013 <br />Each Claim Limit 1,000,000 <br />Retro Date: 12/28/1979 <br />etention: $10,000 <br />Aggregate 1,000,000 <br />DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) <br />"Proof of Coverage" <br />Blanket Additional Insured as per CGD2520103 attached. <br />*CANCELLATION:10-days Notice -Non -Payment of Premium /Non -Reporting of Payroll /30 Days Notice for All <br />Other Reasons. <br />CERTIFICATE HOLDER CANCELLATION <br />r"L <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE <br />WILL BE DELIVERED IN <br />City of Santa Ana <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />Public Works Agency M-21 <br />AUTHORIZED REPRESENTATIVE <br />20 Civic Center Plaza <br />Santa Ana, CA 92702 <br />�> <br />Dona Delight/DLD <br />ACORD 25 (2010/05) <br />INS025 (201005).01 <br />©1988-2010 ACORD CORPORATION. All rights reserved. <br />The ACORD name and logo are registered marks of ACORD <br />