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AcoR" CERTIFICATE OF LIABILITY INSURANCE M,D°"""' 7/116/206/2013 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsements). PRODUCER NAME: ACT Klucher / Bobby Bacon Earl Bacon Agency, Inc. PHONE FAX - 1 Ale No =78-2121 AIC No P.O. Box 12039 E- MAIL Tallahassee FL 32317 ADDREss: ar c n.com INSURER(S) AFFORDING COVERAGE NAIC# INSURER A:Valle Forge Insurance C 0508 INSURED MGTOF-1 INSUR5RBAppefiCan S CO. f Reading, PA 20427 MGT of America, Inc. INSURER C:Con inn 044 Public Resource Management Inc. INSURERD:Transportation Ins. Company 494 2123 Centre Point Blvd. Tallahassee FL 32308 INSURER E: INSURER F: of Casualty Sure CO COVERAGES CERTIFICATE NUMBER: 2063032831 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILTR TYPE OF INSURANCE ADDL INSR SUBRJ WVD POLICY NUMBER POLICY EFF OLIC/YY1'Y POLICY EXP MMUDDIYI'YY LIMITS C GENERAL LIABILITY Y Y 2093390918 /1/2013 11/2014 EACH OCCURRENCE $1,000,000 X DAMAGETORENTED COMMERCIAL GENERAL LIABILITY PREMISES (Ea occurrence) $300,000 CLAIMS-MADE OCCUR MED EXP(Any one person) $5,000 X A-XV Rating PERSONAL &ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $2,000,000 X POLICY PRO LOC $ B AUT OMOBILE LIABILITY V 2093563501 1112013 /1/2014 Eaacci a $1000000 ANY AUTO BODILY I WILEY(Per person) $ ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY (Per accident) $ X X NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Peraccitlent X A-XV Rating $ C X UMBRELLA LIAB X OCCUR 2093563496 11/2013 /1/2014 EACH OCCURRENCE $$5,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $ LED X RETENTION$ 10,000 S A WORKERS COMPENSATION y 3011086712 /112013 /1/2014 U DER- X WCSTAI CA EL b l AND EMPLOYERS' LIABILITY J - e ow D YIN 3011086788 CA /112013 /1/2014 ANY PROPRIETOR/PARTNER/EXECUTIVE? NIA E.L. EACH ACCIDENT $500,000 OFFICER/MEMBER EXCLUDED? (Mandatory In NH) E . L. DISEASE-EA EMPLOYE $500,000 If yes, describe antler DESCRIPTION OF OPERATIONS below E. L. DISEASE-POLICY LIMIT $500,000 F Professional Liability(E&0) 105638880 1112013 /1/2014 Per Claim 2,000,000 Claims-Made Form Aggregate 3,000,000 7/5195 Retro Date; A-XIV DESCRIPTION OF OPERATIONS I LOCATIONS /VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Umbrella: A-XV Rating. All Other Workers' Compp and CA Workers' Comp: A-XV Rating. California Employers Liability Limits: $1,000,000 Each Accident/$1,000,000 Disease Policy LimiU$1,000,000 Disease Each Employee. APPROVED AS TO FORM UCK I IFIUA IC KULUCK UAINUCLLA I ILIN City of Santa Ana 20 Civic Center Plaza (M-30) P.O. Box 1988 Santa Ana CA 92702-1988 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE 11P?49? !r" © 1988-2010 ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD