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ACORn CERTIFICATE OF LIABILITY INSURANCE �fM DATE(MMIDDIYYYY) 0711712013 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 endorsement(s). PRODUCER Cecil W. Powell 8' Co. P.O. Drawer 41490 CONTACT NAME: Brenda Otto PHONE 904.256.0085 904.353.5722 AIC, No, Exl : AIC, No ADDRESS: botto @cwpowellins.com 219 Newnan St. Jacksonville, FL 32203 -1490 INSURER(S) AFFORDING COVERAGE NAIC# INSURER A: Underwriters at Lloyds $ INSURED ELM, Inc. INSURER B: MED EXP(My one person) 1035 Kings Avenue INSURER C: $ Jacksonville, FL 32207 1 INSURER D: GENERAL AGGREGATE NSURER E: GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO- JECT OC PRODUCTS - COMP /OP AGG NSURER F IS COVERAGES CERTIFICATE NUMBER: 2013 Prof Liab 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE 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. LTR TYPE OF INSURANCE INSR WVD POLICYNUM85R P LI L"r (MMIDDIYYYY) (MMIDDII'YYY LIMITS GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY CLAIMS -MADE F7 OCCUR EACH OCCURRENCE $ PREMISES Ea occurrence) $ MED EXP(My one person) $ PERSONAL B ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO- JECT OC PRODUCTS - COMP /OP AGG $ IS AUTOMOBILE LIABILITY ANY AUTO A O SCHEDULED AUTOS HIRED AUTOS AUTOSWNED (Ea accident) $ BODILY INJURY (Per person) $ ILY eraccident BOD INJURY ( ) $ (Per accident) $ UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED RETENTION$ 1 $ WORKERS COMPENSATION AND EMPLOYERS'LIABILITY YIN ANY PROPRIETORIPARTNEWEXECUTIVF❑ OFFICERIMEMBER EXCLUDED? a (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below NIA TORYLIMITS ER E.L. EACH ACCIDENT $ E. L. DISEASE EA EMPLOYE $ E.L. DISEASE - POLICY LIMIT $ A Professional Liability Claims Made Policy ANE10204561 02/2612013 02/2612014 $1,000,000 Limit $15,000 Ded Per Claim DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 141, Additional Remarks Schedule, if more space is required) p0110A CERTIFICATE HOLDER CANCELLATION ©1988 -2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE AraUta 'y1;iC �h ° +C,y OtncN lA,SOLSL'JT1t 4�iTY City of Santa Ana THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE 20 Civic Center Plaza, M36 Sa to Ana, CA 92701 James C. Coleman III CIC/BSO ©1988 -2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD