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ACOR 4e CERTIFICATE OF LIABILITY INSURANCE <br />DATEIMM Dp V, <br />o7 /ir�zoss <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(Sj AUTHORIZED <br />REPRESENTATIVE. OR PRODUCER, AND THE CERTIFICATE HOLDER. <br />IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(las) 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 andorsement(s). <br />PRODUCER <br />Cecil W. Powell & Co. <br />P.O. Drawer 41490 <br />219 Newnan St. <br />Jacksonville, FL 32203 -1490 <br />QQKTACT <br />NAME: Brenda Dtto <br />PHONE 904.256.0065 <br />No Exn: we No): 904.353.5722 <br />_ <br />ObRES5:. lt�cwpowel l itts. COm <br />iO <br />INSURER(S) AFFORDING CPYERAOE. <br />NAI AIC# <br />INSURER A; Underwriters at Lloyds <br />INsuRen ELM, Inc, <br />1035 Kings Avenue <br />Jacksonville, FL 32207 <br />INSURERS: <br />$. <br />INSURERC: <br />$. <br />INSURER D: <br />_ <br />INSURER E: <br />INSURER F1 <br />MED EXP(Anyone person) <br />COVERAGES CERTIFICATE NUMBER: 2013 ProF Liab REVISION. NUMBER:. <br />THIS IS TO CERTIFY THAT THE POLICIES O INSURANCE LISTED BELOW BEEN ..ISSUED TO THE INSURED NAMED MOVE FOR THE LIC 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 />LTR <br />TYPE OF INSURANCE <br />INSR <br />W <br />MMiDDIYYYY <br />MNODNYYY <br />LIMITS. <br />GENERAL LIABILITY <br />EACH OCCURRENCE <br />$. <br />PREMISES( €a occurrence <br />$. <br />COMMERCIAL GENERAL LIABILITY <br />CLAIMS -MADE OCCUR <br />MED EXP(Anyone person) <br />$ <br />PERSONAL &ADVINJURY <br />GENERAL AGGREGATE. <br />$. <br />GEN'L AGGREGATE LIMIT APPLIES PCR: <br />PRODUCTS.- COMPIOPAGG <br />POLICY ,ICd LOO <br />AUTOMOBILE <br />LIABILITY <br />UUMUINLU <br />accident. <br />$ <br />BODILY INJURY(Par person) <br />$ <br />ANYAUTO <br />AUTO$NED AUTOSULED <br />HIREDAUTOS NONAWNED <br />AUTOS <br />BODILY INJURY(Per accident}.$ <br />- <br />An aecldvn <br />UMBRELLA LIAB <br />OCCUR. <br />EACH:OCCURRENCE <br />$ <br />EXCESSLIAB <br />CLAIMS,MADE <br />.AGGREGATE <br />$- <br />DEO <br />RETENTIONS. <br />$ <br />WORKERS COMPENSATION - <br />AND EMPLOYERS' LIABILITY YIN <br />ANY PRQPRIETOWPNZTNER/EXLCUTIV <br />OPROFR/MEMEER EXCLUDEDT <br />NIA <br />TORY LIMBS ER <br />EL. EACH ACCIDENT <br />$ <br />BL, .DISEASE - EA EMPLOYEE <br />$ <br />(Maadamry In NH) <br />desenboender <br />E.I.; DISEASE- POLICY LIMIT <br />$" <br />0keg, <br />DESCRIPTION OF OPERATIONS below <br />A <br />Professional Liability <br />Claims Made Palley <br />ANE1020456. <br />02126/2013 <br />62126/2014 <br />$1,000,060 Limit <br />$15,000 Oed Per Claim <br />ORSCRIPTION OP OPERATONS/ LOCATION$ I VEHICLES (Adkoh AGORD 401, AddltY..1 Remarks ScheduieJf mnmeuade rs repuiradt <br />s f3k4J .,,) <br />CERTIFICATE HOLDER CANCELLATION <br />t,y ,•„ Y`t, �. <br />�Fl <br />�vs�lstatT[ (�iLY p�ctGT�c' <br />City OP Santa Ana <br />THE EXPIRATION DATE THVEDESC NOTICE POLICIES IL E CANCELLED BIfPORE <br />THEE %PIRATION DATE THEREOF', NtlTtCE WILL BE DELIVERED IN <br />ACCDROANC E WITH THE POLICY PROVISION& <br />AUTHORIZED. REPRESENTATIVE,_ <br />20 Civic Center Plaza, M36 <br />Sa to Ana, CA 92701 <br />James C. Coleman 1371 GLC /BSO <br />6 1 988 -201 0 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD <br />