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A� bP CERTIFICATE OF LIABILITY INSURANCE
<br />DATE (MMIDD)YYYY
<br />7/24/2014 '
<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 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 />Hayward Tilton & Rolapp Insurance Associates,
<br />CA Dept. of Ins. Lic. #0614365
<br />888 S. Disneyland Dr., Ste 400
<br />Anaheim CA 92802-1846
<br />CONTACT Sue Reams
<br />PHONE (714) 905-1923 FAX (714)905-1910
<br />ac No:
<br />nooaiess:suer@htrinsure.com
<br />INSURERS AFFORDING COVERAGE I #
<br />INSURER A:Travelers Indemnity Cc of CT 25658
<br />INSURED
<br />Mullen & Associates, Inc.
<br />1200 N. Jefferson Street
<br />Suite D -/�,
<br />Anaheim CA 92807 ('��
<br />INSURER B:Preferred Employers Ins Cc 10900
<br />INSURERC:U S Specialty Ins Cc 29599
<br />INSURER D:
<br />INSURER E:
<br />INSURER F:
<br />COVERAGES CERTIFICATE NUMBER:2014 COL All LInes 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 />ADDLSUBR
<br />POLICY NUMBER
<br />POLICY EFF
<br />MM/DDM'YY
<br />POLICY EXP
<br />MMIDDIYYYY
<br />LIMITS
<br />Ross Annex
<br />GENERAL LIABILITY
<br />Santa Ana, CA 92701
<br />Sue Reams/SMR
<br />EACH OCCURRENCE $ 1,000,000
<br />X COMMERCIAL GENERAL LIABILITY
<br />DAMAGE I RENTED
<br />PREMISES Ea accurr $ 300,000
<br />A
<br />CLAIMS -MADE OCCUR
<br />X
<br />Y
<br />6802D291163
<br />07/24/201407/24/2015
<br />MED EXP (Any one person) $ 5,000
<br />PERSONAL &ADV INJURY $ 1,000,000
<br />GENERAL AGGREGATE $ 2,000,000
<br />GEN'L AGGREGATE
<br />LIMIT APPLIES PER:
<br />PRODUCTS - COMP/OP AGG $ 2,000,000
<br />X POLICY
<br />PRO- LOC
<br />$
<br />AUTOMOBILE
<br />LIABILITY
<br />EO MBI tlEEDI SINGLE LIMIT 1,000,000
<br />BODILY INJURY (Per person) $
<br />A
<br />ANY AUTO
<br />BODILY INJURY (Per accident) $
<br />ALL OWNED SCHEDULED
<br />6802D291163
<br />07/24/201407/24/2015
<br />AUTOS AUTOS
<br />X
<br />HIRED AUTOS X AUTOOWNEO
<br />OPM
<br />cidenROPERTYt AMAGE
<br />pe accident)
<br />UMBRELLA
<br />$
<br />.��
<br />LAB
<br />OCCUR
<br />EACH OCCURRENCE $
<br />$
<br />EXCESS LAB
<br />CLAIMS-MADEAGGREGATE
<br />DED RETENTION
<br />. SJORC
<br />$
<br />B
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS'LIABILITY
<br />!r
<br />Glty Q
<br />®
<br />WC STATU- OTH-
<br />X
<br />E. I EACH ACCIDENT $ 1,000,000
<br />YIN
<br />ANY PROPRIETOR/PARTNER/EXECUTIVE❑
<br />TS§($tent
<br />OFFICER/MEMBER EXCLUDED?
<br />(Mandotory in NH)
<br />NIA
<br />133245-B
<br />02/4/2014
<br />02/4/2015
<br />EI DISEASE - EA EMPLOYEE $ 1,000,000
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE -POLICY LIMIT $ 1,000,000
<br />C
<br />Professional Liability
<br />ISS1424571
<br />01/4/2014
<br />01/4/2015
<br />Each Claim Limit 1,000,000
<br />Errors & Omissions
<br />etention : $15,000
<br />Aggregate 1,000,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required)
<br />City of Santa Ana, 20 Civic Center Plaza, Santa Ana, CA 92701, its officers, employees, agents,
<br />volunteers and representatives are named as additional insured with regard to general liability & arising
<br />from the operations and uses performed by or on behalf of the named insured.per policy form CG D3 81 09
<br />07, includes Primary and Non Contributory Wording.
<br />*CANCELLATION:10-days Notice for Non -Payment of Premium/Non-Reporting of Payroll/30 days for all other
<br />reasons.
<br />CERTIFICATE HOLDER CANCELLATION
<br />mbootha@santa-ana.org
<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 />Public Works Agency
<br />AUTHORIZED REPRESENTATIVE
<br />20 Civic Center Plaza, 3r Flr,
<br />Ross Annex
<br />Santa Ana, CA 92701
<br />Sue Reams/SMR
<br />ACORD 25 (2010/05)
<br />INS025 mnlnnsl m
<br />©1988-2010 ACORD CORPORATION. All rights reserved.
<br />Th. ACr1RT1 name anA Innn orn runiehnrnA rnairi of Arni
<br />
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