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<br />I%IILLEN ASSOCIATES tTi A -2014-087E111 VV C BY
<br />,' R - EUNICE HEREDIA (PG 1 OF 3)
<br />A C"R.a
<br />CERTIFICATE OF LIABILITY INSURANCE
<br />DATE (MMIDDNYYY)
<br />7/29/2015
<br />THIS 'CERTIFICATE IS ISSUED AS A. MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIF'ICAT'E 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, Inc.
<br />CA Dept, of Ins, lie. #0614365
<br />888 S. Disneyland Dr., Ste 400
<br />Anaheim CA 92802-1.846
<br />CONTACT Sue Reams
<br />NAME:
<br />PHONE(714) 905-1923 AX Nle: (714)90$-1910
<br />AIL
<br />ADDREESS:suer@htrinsure.com
<br />INSURERS AFFORDING COVERAGE NAICN
<br />INSURERA:Travelers Indemnity Com an 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 Co
<br />INSURERC:U S Specialty Insurance Co.__
<br />INSURER D;
<br />INSURER E
<br />INSURER F:
<br />M=N12Inf6l0 =11101 II Irl -41 r7.=l rr1111.111111
<br />THIS IS TOCERTIFY 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 PAM CLAIMS.
<br />INSR
<br />''.... LTR
<br />TYPE OF INSURANCE
<br />ADDL
<br />J=
<br />SUER
<br />WVDPOLICY
<br />NUMBER
<br />POLICY EFF
<br />(MM DD ))
<br />POLICY EXP
<br />((MMIDDXYYYY
<br />LIMITS
<br />A
<br />X COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE X OCCUR
<br />EACH OCCURRENCE $ 1,000,000
<br />DAMAGE TO RENTER
<br />REMISESIEa occurrence. $.. 300,000
<br />MED EXP (Any one person) $ 5,000
<br />X
<br />6802D291163 TCT 15
<br />7/24/2015
<br />7/24./2016
<br />PERSONAL BADV INJURY $. 1,000,000
<br />GEN'L AGGREGATE LIMIT APPLIES P'ER:
<br />GENERAL AGGREGATE $ 2,000,000
<br />X POLICY 71 ECT Fâ] LOC
<br />PRODUCTS - COMPIOP AGG $ 2,000,000
<br />Num -awned $ included
<br />OTHER:
<br />AUTOMOBILE
<br />LIABILITY'
<br />COEa M accident. DINED SINGLE LIMIT $
<br />BODILY INJURY (Per person).. $
<br />ANY ' AUTO
<br />AL OSCHEDULED
<br />AUTOS AUTOS
<br />6802D291163 TCT 15
<br />.... 7/24./2015
<br />7/24/2015
<br />BODILY INJURY (Per accident) $
<br />NEON -OWNED
<br />HIRED AUTOS X AUTOS
<br />PROPERTY DAMAGE
<br />Pet accident $
<br />Hired& Non OwnedAelo $ 1,000,000
<br />UMBRELLA LIAB
<br />OCCUR
<br />EACH OCCURRENCE '..... $
<br />AGGREGATE $
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />DED '...... RETENTION$
<br />'..... $
<br />$
<br />WORKER'S COMPENSATION
<br />AND EMPLOYERS' LIABILITY YIN
<br />ANY PROPRIETOPJPARTNER4EXECUTIVIE
<br />CIFFICERIN12MBER EXCLUDEC? â
<br />IMandatory in NH)
<br />II yes, describe under
<br />N d A
<br />WEN133245 9
<br />2/4/2015
<br />2/4./2016
<br />X PEROTH-
<br />STATUTE ER
<br />E.L. EACH ACCIDENT $ 1,000 , 000
<br />E.L. DISEASE - EA EMPLOYE $ 1,000 000
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE_- POLICY LIMIT $ 1,000,000
<br />C
<br />Professional Liability
<br />USS 15 25508
<br />01/04/2015
<br />01/04/2016
<br />Each Claim Limit $ 1,000,000
<br />Errors & Omissions
<br />Aggregate $ 1,000,000
<br />DESCRIPTION OF OPERATION'S 1 LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required)
<br />As required by Written Contract, City of Santa. Ana, 20 Civic Center Plaza, Santa Ana, CA 92701, its
<br />officers, employees, agents, volunteers and representatives are included as additional insured with
<br />regard to general liability & arising from the operations and uses performed by or on behalf of the named
<br />insured per policy form CG D3 81 09 07, includes Primary and Non Contributory Wording.
<br />*CANCELLATION:10-days Notice for Nan -Payment of Premium/Non-Reporting of Payroll/30 days for all other
<br />reasons.
<br />mbacthe@santa-ana.org
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />City of Santa Ana THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />Public Works Agency ACCORDANCE WITH THE POLICY PROVISIONS.
<br />20 Civic. Center Plaza, 3r F"lr,
<br />Ross Annex AUTHORIZED REPRESENTATIVE
<br />Santa Ana, CA 92701
<br />Daae Reams/SMR
<br />Uc 1;198B-2014 ACORD CORPORATION. All rights reserved
<br />ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD
<br />INS025 ipniani1
<br />
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