|
A11 CCCERTIFICATE OF LIABILITY INSURANCE
<br />MMIDDIYY
<br />DATE (2/3/206YY)
<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, Inc.
<br />CA Dept. of Ins. Lic. #0614365
<br />888 S. Disneyland Dr., Ste 400
<br />Anaheim CA 92802-1846
<br />CONTACT
<br />NAME: Sue Reams
<br />PHONE(714) 905-1923 FAC No; (714)905-1910
<br />AIL
<br />ADDRESS: suer@htrinsure. com
<br />INSURERS AFFORDING COVERAGE NAIC #
<br />INSURERA:Travelers Indemnity Company 25658
<br />INSURED
<br />Mullen & Associates, Inc.
<br />1200 N. Jefferson Street Suite D
<br />Anaheim, CA 92807
<br />INSURER B :Preferred Employers Ins Cc
<br />INSURERC:U S Specialty Ins CO 29599
<br />INSURER D:
<br />INSURER E
<br />INSURER F
<br />COVERAGES CERTIFICATE NUMBER:lb—1 / All Lines RFVISI()N NIIMRFR-
<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 />ADDL
<br />SUBR
<br />POLICY NUMBER
<br />POLICY EFF
<br />MM/DD/YYYY
<br />POLICY EXP
<br />MM/DD/YYYY
<br />LIMITS
<br />X COMMERCIAL GENERAL LIABILITY
<br />EACH OCCURRENCE $ 1,000,000
<br />A
<br />CLAIMS -MADE [i]OCCUR
<br />DAMAMGISES E TO Ea RENTED ccurrence $ 300,000
<br />PRE
<br />MED EXP (Any one person) $ 5,000
<br />X
<br />6802D291163 TCT 16
<br />7/24/2015
<br />7/24/2016
<br />PERSONAL &ADV INJURY $ 1,000,000
<br />GEML AGGREGATE LIMIT APPLIES PER:
<br />GENERAL AGGREGATE $ 2,000,000
<br />X POLICY PRO-
<br />JECT F—] LOC
<br />PRODUCTS - COMP/OP AGG $ 2,000,000
<br />Non -owned $ included
<br />OTHER:
<br />AUTOMOBILE
<br />LIABILITY
<br />COEaMBINED accident SINGLE LIMIT $ 1,000,000
<br />BODILY INJURY (Per person) $
<br />ANY AUTO
<br />A
<br />X
<br />ALL OWNED SCHEDULED
<br />AUTOS AUTOS
<br />NON -OWNED
<br />HIRED AUTOS X AUTOS
<br />6802D291163 TCT 16
<br />7/24/2015
<br />7/24/2016
<br />BODILY INJURY (Per accident) $
<br />PROPERTY DAMAGE
<br />Per accident $
<br />$
<br />UMBRELLA LAB
<br />HCLAIMS-MADE
<br />OCCUR
<br />EACH OCCURRENCE $
<br />AGGREGATE $
<br />EXCESS LIAB
<br />DED I I RETENTION $
<br />$
<br />WORKERS COMPENSATIONPER
<br />AND EMPLOYERS' LIABILITY Y / N
<br />OTH-
<br />X STATUTE ER
<br />EACH ACCIDENT $ 1,0 0 000
<br />B
<br />ANY PROPRIETOR/PARTNER/EXECUTIVEE.L.
<br />OFFICER/MEMBER EXCLUDED?
<br />(Mandatory in NH)
<br />NIA---
<br />WKN133295 10
<br />2/4/2016
<br />2/4/2017
<br />E.L. DISEASE - EA EMPLOYE $ 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 Liablity
<br />USS1626400
<br />1/4/2016
<br />1/4/2017
<br />Each Claim Limit $1,000,000
<br />Errors & Omissions
<br />Aggregate $1,000,000
<br />DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
<br />Agreement # A-2014-087
<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 />mboothe@santa-ana.org
<br />City of Santa Ana
<br />Public Works Agency
<br />20 Civic Center Plaza, 3r Flr,
<br />Ross Annex
<br />Santa Ana, CA 92701
<br />GANGtLLA I IUN
<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 />AUTHORIZED REPRESENTATIVE
<br />is
<br />Sue Reams/SMR
<br />©1988-2014 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2014/01) The ACORD name and logo are reg lstered,marks of ACORD
<br />I NS025 rom am i,�
<br />11� VIF1lVLlD F'1Y:.,d , - 71—,_
<br />_ � LINKIE P li_iil_DIA (I -IG I OFro"„�)
<br />
|