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4� orzca® CERTIFICATE OF LIABILITY INSURANCE <br />DATE(MMIDDYYVV) <br />12/23/2013 <br />�' HIS 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 />CONTACT <br />NAME: <br />PHONN E.(FAX <br />AC Not: <br />Dealey, Renton & Associates <br />P. 0. Box 10550 <br />Santa Ana CA 92711-0550 /� A <br />EMAIL <br />ADDRESS: <br />INSURERS AFFORDING COVERAGE <br />_ <br />NAIC# <br />N/ ��1LaJann�Q� ^ 099�� <br />INSURER A:Travelers Property A <br />25674 <br />_�S "�NC:Vb-�°Z'li t.® _ <br />INSURED <br />INSURER B:Travelers Indemnity QQ, Qf Qonnecti <br />25682 <br />INSURER C:T v lers Casualty& Surety Co. Anne <br />31194 <br />Michael Brandman Associates <br />INSURER D : <br />DAMAGE TO ENTED <br />PREMISES Ea occ r $1,000,000 <br />220 Commerce Center #200 <br />Irvine CA 92602 <br />�LIABILITY <br />CLAIMS -MADE LOCCUR <br />INSURER E: <br />INSURER F, <br />_ <br />MED EXP lAny oneperson) $10,000 <br />PERSONAL &ADV INJURY $1,000,000 <br />COVERAGES CERTIFICATE NUMBER: 1092215039 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 />INSR <br />S BR <br />WVD <br />POLICY NUMBER <br />POLICY EFF <br />MM/DDIYYYY <br />POLICY EXP <br />MMIDD/YYYY <br />"LIMITS <br />B <br />GENERAL LIABILITY <br />Y <br />68060831-204 <br />1/1/2014 <br />/1/2015 <br />EACH OCCURRENCE $11000,000 <br />X COMMERCIAL GENERAL <br />DAMAGE TO ENTED <br />PREMISES Ea occ r $1,000,000 <br />�LIABILITY <br />CLAIMS -MADE LOCCUR <br />_ <br />MED EXP lAny oneperson) $10,000 <br />PERSONAL &ADV INJURY $1,000,000 <br />X Contractual <br />_ <br />Liability <br />_ <br />GENERAL AGGREGATE $2,000,000 <br />GEN'LAGGREGATE LIMIT APPLIES PER: <br />PRODUCTS - COMP/OPAGG $2,000,000 <br />Deductible $None <br />POLICYFX I PRO- 7LOC <br />EcT <br />A <br />AUTOMOBILE <br />LIABILITY <br />BA6078L716 <br />1/1/2014 <br />/1/2015 <br />COMBINED IN LE TMTT— <br />Ea accident $1,000,000 <br />LOU ILY I NJURV(Per person) $ <br />X <br />ANY AUTO <br />ALL OWNED SCHEDULED <br />AUTOS AUTOS <br />OV A <br />TOFOR <br />1i <br />BODILY INJURY (Per accident) $ <br />PPe�a ci6ent ANIAGE $ <br />X <br />HIREDAUTOS X NON-OAUTOSWNED <br />$ <br />Deductible None <br />UMBRELLA LIAR <br />OCCUR <br />—ILO f <br />EACH OCCURRENCE $ <br />ffo—DUE <br />AGGREGATE $ <br />EXCESS LIAB <br />CLAIMS -MADE <br />pp <br />• O• <br />taiyAttomey <br />DED RETENTION $ <br />1 1 $ <br />A <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY YIN <br />UB1427T762 <br />1/1/2014 <br />/1/2015 <br />X I WCSTATU- OTH- <br />ER <br />ANY PROPRIETOWPARTNER/EXECUTIVE❑ <br />OFFICEWMEMBER EXCLUDED? <br />NIA <br />E.L. EACH ACCIDENT $1,000,000 <br />(Mandatory In NH) <br />E. L. DISEASE - EA EMPLOYEE $1,000,000 <br />It yes, tlescri0 under <br />DESCRIPTION OF OPERATIONS below <br />EL DISEASE -POLICY LIMIT $1,000,000 <br />C <br />Professional Liability Y <br />_ <br />106035068 <br />1/1/2014 <br />/1/2015 <br />Per Claim $2,000,000 <br />Claims Made <br />Annual Aggr. $2,000,000 <br />DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) <br />General Liability policy excludes claims arising out of the performance of professional services. <br />The City of Santa Ana, Its officers and employees are additional insureds as respects general liability as required by written contract. <br />CERTIFICATE HOLDER CANCELLATION 30 Day/1 0 Day Notice for Non -Payment <br />ACORD 25 (2010105) <br />© 1988-2010 ACORD CORPORATION. All rights reserved. <br />The ACORD name and logo are registered marks of ACORD <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />City of Santa Ana <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />Attn: LarryYenglin <br />20 Civic Center Plaza <br />Santa Ana CA 92701 <br />AU RIZED REPRESENTATIVE <br />ACORD 25 (2010105) <br />© 1988-2010 ACORD CORPORATION. All rights reserved. <br />The ACORD name and logo are registered marks of ACORD <br />