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<br />CERTIFICATE OF LIABILITY INSURANCE
<br />DATE(MMIDD
<br />3/ 12/2015 15
<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 b fjdoil9ed.[ If�Sl�q[tOgATION IS WAIVED, subject to
<br />the terms and conditions of the policy, certain policies may require an endorsement. A statement un this Ce4tI icate Hogs not confer rights to the
<br />certificate holder in lieu of such endorsement(s).
<br />PRODUCER
<br />.Millennium Corporate Solutions
<br />License (% OC13480
<br />5530 Trabuco Road
<br />Irvine CA 92620
<br />NAMEACT June L444n0F /5 I,' °`A
<br />PHONE E,ol. (94 r 60715'- _''FAX (949)679 -6607
<br />M..jlarson@=sins.com
<br />INSURERS AFFORDING COVERAGE
<br />NAIC N
<br />INSURER A:Banover Insurance AXV
<br />2292
<br />7 IN RED Fieldman, Rolapp & Associates, Inc.
<br />ieldman, Rolapp Financial Services, LLC
<br />Applied Best Practices, LLC
<br />19900 MacArthur Blvd. Suite 1100
<br />Irvine CA 92612
<br />INSURER B.Lloyds of London A +XV)
<br />85202
<br />I INSURER C:
<br />NSURER O:
<br />:N NSURER E:
<br />$ 1,000,000
<br />INSURER F:
<br />$ 1,000,000
<br />COVERAGES CERTIFICATE NUMBER:15 -16 AI 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 />City Of Santa Ana
<br />J=
<br />POLICY NUMBER
<br />POLICY EFF
<br />IMMIDDfYYYYI
<br />POLICY EXP
<br />(MMIDDfYYYY)
<br />LIMITS
<br />Santa Ana, CA 92701
<br />GENERAL LIABILITY
<br />c -- -
<br />June Larson /JANI
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />PREMISES Ea ocovrrence
<br />$ 1,000,000
<br />A
<br />X COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE OCCUR
<br />H3 A578667 00
<br />/1/2015
<br />/1/2016
<br />MED EXP(Any one person)
<br />$ 10,000
<br />PERSONAL B ADV INJURY
<br />$ 1,000,000
<br />GENERAL AGGREGATE
<br />$ 2,000,000
<br />GENT AGGREGATE LIMIT APPLIES PER
<br />PRODUCTS - COMP/OP AGO
<br />$ 2,000,000
<br />X POLIGY I PRO 7 LOC
<br />$
<br />AUTOMOBILE
<br />LIABILITY
<br />COMBINED SINGLE SINGLE LIMIT
<br />1,000,000
<br />BODILY INJURY (Per person)
<br />$
<br />A
<br />ANY AUTO
<br />ALL OWNED SCHEDULED
<br />AUTOS AUTOS
<br />OH3 A578667 00
<br />/1/2015
<br />/1/2016
<br />BODILY INJURY (Per accident)
<br />$
<br />X
<br />PROPERTY DAMAGE
<br />fPer accident
<br />$
<br />HIRED AUTOS X NON -OWNED
<br />AUTOS
<br />X
<br />UMBRELLA UAB
<br />X
<br />OCCUR
<br />EACH OCCURRENCE
<br />$ 3,000,000
<br />AGGREGATE
<br />$
<br />A
<br />EXCESS LIAR
<br />CLAIMS -MADE
<br />DELI I I RETENTION
<br />$
<br />H3 A578667 00
<br />/1/2015
<br />/1/2016
<br />WORKERS COMPENSATION
<br />I WC STATUS OTH-
<br />AND EMPLOYERS! LIABILITY YIN
<br />ANY PROPRIETORIPARTNER/EXECUTIVE ❑
<br />OFFICERIMEMBER EXCLUDED?
<br />NIA
<br />/
<br />N ER
<br />E.L. EACH ACCIDENT
<br />$
<br />E . DISEASE - EA EMPLOYE
<br />$
<br />(Mandatory in NH)
<br />/
<br />N yes, describe under
<br />'
<br />DESCRIPTION OF OPERATIONS below
<br />E . DISEASE - POLICY LIMIT
<br />$
<br />B
<br />Errors 6 Omission
<br />SUANS200491401
<br />12/20 /2014
<br />12/20/2015
<br />Aggregate $2,000,000
<br />Retro date 12/20/2004
<br />laims Made Policy
<br />Retention $250,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS /VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required)
<br />The City of Santa Ana, it's officers, employees, agents and representatives are named as additional
<br />insured as per form attached.
<br />30 days notice shall be mailed for policy cancellation.
<br />CERTIFICATE HOLDER CANCELLATION
<br />ACORD 25 (2010/05) C 1988 -2010 ACORD CORPORATION. is reserySIR.
<br />INS02519nim5%n1 Tho Annion nama nnA Innn nna ronicta ad nn,s Arc of ACr1Rr1 _ -s - - --
<br />Tev,ler�w _n
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />City Of Santa Ana
<br />Finance & Management Services Agency
<br />AUTHORIZED REPRESENTATIVE
<br />20 Civic Center Plaza
<br />Santa Ana, CA 92701
<br />c -- -
<br />June Larson /JANI
<br />ACORD 25 (2010/05) C 1988 -2010 ACORD CORPORATION. is reserySIR.
<br />INS02519nim5%n1 Tho Annion nama nnA Innn nna ronicta ad nn,s Arc of ACr1Rr1 _ -s - - --
<br />Tev,ler�w _n
<br />
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