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ACGORO® CERTIFICATE OF LIABILITY INSURANCE
<br />DATE UMMIDDIYYYY)
<br />5/1212014
<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(les) 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 IOA Insurance Services
<br />130 Vantis, Suite 250
<br />Aliso Viejo, CA 92656
<br />CONTA T
<br />NAME: Betty Iran _
<br />PHONE FAx
<br />949 -297 -5962 ac Rol: 949- 297 -5960
<br />E-MAIL
<br />ADORass: belt .tran loausa.com
<br />INSURER(S) AFFORDING COVERAGE
<br />NAICN
<br />,�
<br />wsURERA: RLI Insurance Company
<br />13056
<br />waJoausaxom CA License #OE67768
<br />INSURED
<br />Joseph C. Truxaw and Associates, Inc.
<br />265 S. Anita, Suite 111
<br />INSURER B:
<br />$ 1,000,000
<br />INSURER D
<br />CLAIMS -MADE F—AOCCUR
<br />Prim /NonCon
<br />INSURER D:
<br />Orange CA 92868
<br />INSURER E:
<br />INSURER F :
<br />$ 1,000,000
<br />✓
<br />COVERAGES CERTIFICATE NUMBER: 20149654 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 />EXCLUSIONSAND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />QTR
<br />TYPE OFINSURANCE
<br />ADD
<br />p
<br />5 BR
<br />POLICY NUMBER
<br />POLICY EFF
<br />MMIDOfIYYV
<br />POLICY EXP
<br />MMIDD/1'YYY
<br />LIMITS
<br />A
<br />COMMERCIAL GENERAL LIABILITY
<br />,�
<br />�/
<br />PS80001269
<br />10/3112013
<br />10131/2014
<br />EACHOCCURRENCE
<br />$ 1,000,000
<br />CLAIMS -MADE F—AOCCUR
<br />Prim /NonCon
<br />Scheduled Al Each
<br />#PPB3130212
<br />Professional Services
<br />performed by the Insured
<br />—DAMAGE TO IEA re,EDence
<br />9HJ$EeAn
<br />$ 1,000,000
<br />✓
<br />M one ar.nn
<br />$ 10,000
<br />Wvr of Subr
<br />PERSONAL a ADV INJURY
<br />$ 1,000,000
<br />AGGREGATE LIMIT APPLI ES PER:
<br />GENERAL AGGREGATE
<br />$ 2,000,000
<br />GENT
<br />are Excluded
<br />JECT POLICY 0IRO- ✓�LOC
<br />PRODUCTS. COMPIOP AGO
<br />$ 2,000,000
<br />S
<br />OTHER',
<br />A
<br />AUTOMOBILE
<br />LIABILITY
<br />./
<br />,/
<br />PSA0001069
<br />10/31/2013
<br />10/31/2014
<br />CO 6INEOSINGLELIMIT
<br />Ea accident
<br />$ 1,000,000
<br />VV
<br />ANY AUTO
<br />ALL OWNED BGHEDULED
<br />LIT
<br />AUTOS — NON OWNED
<br />HIREDAUTOS ✓_ AUTOS
<br />Designated Insured Endt
<br />#CA20481013; Prim /NonCon
<br />and Bikt Wvr of Subr
<br />included on pg 2 of Form
<br />BODILY INJURY (Per person)
<br />S
<br />BODILY INJURY (Per accident)
<br />$
<br />PROPERTY DAMAGE
<br />Per accident
<br />$
<br />s
<br />rim /NonCon War of Subr
<br />#PPA3000313
<br />A
<br />UMBRELLA LIAR
<br />✓
<br />OCCUR
<br />PSE0001215
<br />10/3112013
<br />10/31/2014
<br />EACH OCCURRENCE
<br />s 4000000
<br />EXCESS LIAR
<br />CLAIMS -MADE
<br />Following Form; Excludes
<br />Professional Liability
<br />AGGREGATE
<br />S 4,D00,000
<br />DED
<br />RETENTION $
<br />�—
<br />5
<br />A
<br />AND WORKERS
<br />EMPLOYERS' COMPENSATION
<br />AND EMPLOVER$'LIABILITY
<br />ANY PROPRIETORIPARTNERIEXECUTIVE YIN
<br />OFFICERIMEMDER EXCLUDED?
<br />(Mandatory In Nall
<br />byes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />NIA
<br />PSW0001252
<br />Waiver of Subrogation
<br />Endt #WC0403060484
<br />r�
<br />2
<br />1013112013
<br />� .AS
<br />10/31/2014
<br />r�® "C�
<br />STATUTE ERH
<br />EACH ACCIDENT
<br />_
<br />S 1,000,000
<br />E. L. DISEASE - EA EMPLOYEE
<br />$ 1,000,000
<br />E.L. DISEASE - POLICY LIMIT
<br />$ 1,000,000
<br />iSA S
<br />ORCK
<br />Attorney
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD101,Additional Remark.Sch.dule, a ahedif mare.,ago a,.quired)
<br />Certificate Holder Is an Additional Insured with respect to General Liability (GL) and Automobile Liability but only when required by written contract
<br />with the Insured prior to an occurrence as per Endorsements noted above. GL Includes Separation of Insureds and Contractual Liability per limitations
<br />in the BusinessOwners' Coverage form. A Workers' Compensation Waiver of Subrogation as noted above is included for the person or organization named
<br />in the Schedule that are parties to a contract requiring this Endorsement, provided that contract is executed before the loss. Coverage subject to all
<br />policy terms, conditions, limitations and exclusions. 30 Day Notice of Cancel /10 Days for Non - Payment In accordance with policy provisions.
<br />CERTIFICATE HOLDER CANCELLATION
<br />City of Santa Ana
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />P.O. Box 1988
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />20 Civic Center Plaza (M -30)
<br />Santa Ana CA 92702 -1988
<br />AUTHORIZED REPRESENTATIVE
<br />(AVC) Alicia K. (gram
<br />© 1988 -2014 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD
<br />CERT NO.: 20149654 (AVC) SaLtY Tian 5/12/2014 10:43:37 M (PDT) Page 1 of 5
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