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A-2'014-100
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<br />AC�)Q� CERTIFICATE OF LIABILITY INSURANCE
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<br />DACE (MM1DD,cr'YYY)
<br />111612014
<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 IINSURED, the policy('ies) midst 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 conifer rights to the
<br />certificate holder in lieu of such endorsement(s),
<br />PRODUCER IOA Insurance ServV ces
<br />130 Vantis, Suite 250
<br />AIisD Vie jo, CA 92656
<br />CONTACT
<br />NAME: Betty Tran
<br />PHONE 949.297 -5962 [ArX,N0): 040 -297 -5960
<br />1A EXD�
<br />E -MAIL
<br />ADDRESS: bett .trait. loausa.com
<br />INSURER, 5 AFFORDING COVERAGE
<br />NAIC #
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<br />INSURER A : RLI Insurance Company
<br />13056
<br />www,ioausa.com CA License #OE67768
<br />INSVREID
<br />Joseph C. Truxaw and Associates, Inc.
<br />265 S. Anita, Suite 111
<br />INSURER 9:
<br />$ 1,000,000
<br />NsuRERC:
<br />CLAIMS -MADE OCCUR
<br />`°
<br />Prim /NonCon
<br />INSURER D.
<br />Orange CA 92868
<br />E
<br />-INSURER
<br />INSURER F u
<br />$ 1,000,000
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<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 />IINSR......
<br />LTR
<br />TYPE OF INSURANCE
<br />ADDL
<br />INSD
<br />SUBR
<br />WV0
<br />POLICY NUMBER
<br />POLICY EFF
<br />IMM;DDPYYYY
<br />POLICY' EXP
<br />MWDD1YYYY'
<br />LIMITS
<br />•
<br />V
<br />COMMERCIALGENERALLIABILITY
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<br />y/
<br />':PSB0001259
<br />10/31/2014
<br />10/3112015
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />CLAIMS -MADE OCCUR
<br />`°
<br />Prim /NonCon
<br />Scheduled Al Endt
<br />#PPB3130212
<br />Professional Services
<br />DAMAGE TC� RENTED
<br />PREMISES occurrence
<br />$ 1,000,000
<br />✓
<br />MED EXP (Any one person)
<br />$ 10,000
<br />✓
<br />Wvr of Subr
<br />PERSONAL BADV INJURY
<br />$ 1,000,000
<br />performed by the Insured
<br />GEN'L AGGREGATE LtlMIT APPLIES PER:
<br />GENERAL AGGREGATE
<br />$ 2,000,.000
<br />are Excluded
<br />POLICY ® PECCT- I LCC
<br />PRODUCTS - COMPIOP AGO
<br />$ 2,000,000
<br />$
<br />OTHER:
<br />•
<br />AUTOMOBILE
<br />LIABILITY
<br />AUTO
<br />ALL OWNED SC-4EDULED
<br />AurOS NON-O
<br />HIRED AUTOS AUTOSWNED
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<br />✓
<br />PSA0001069
<br />Designated Insured Endt
<br />#CA204S1013;. Prim /NonCon
<br />and Blkt Wvr of Subr
<br />Included on pg 2 of Form
<br />10/31/2014
<br />1013112015
<br />COMBINED SINGLE (LIMIT
<br />Eaacciderl
<br />$ 1,000,000
<br />_
<br />BODILY INJURY (Peer person)...
<br />$
<br />a,/ANY
<br />BODILY tlNJURY (Per accident)
<br />$
<br />PROPERTY PAINAGE
<br />$
<br />$
<br />rim /Non'Con J Wvr of Subr
<br />#PPA3000313
<br />A
<br />UMBRELLA LAB ,/ OCCUR
<br />PSE0001215
<br />10/31/2014(10/31
<br />/2015
<br />EACH OCCURRENCE
<br />5,000000
<br />EXCESS LIAR CLAIMS -MADE
<br />DED '... RETENTIION$
<br />Following Form; Excludes
<br />Profess'ional Liability
<br />AGGREGATE
<br />5,000,000
<br />A
<br />WORKERS COMIPENSATION
<br />AND EMPLOYERS" LIABILITY Y J N
<br />ANY PROPRIETORJPARTNERPEXECUTIE
<br />OFFIOERIMEMBER EXCLUDED? ®
<br />(Mandatory in NH)
<br />N 1 A
<br />PSWO001252
<br />Waiver of Subrogatllon
<br />Endt. #WC0403060484
<br />10131/2014
<br />10/31/2015
<br />/ PEATUTE O-rH-
<br />TATUTE ER
<br />k
<br />E.L. EACH ACCIDIENT
<br />1 ,000,000
<br />E.L. DISEASE - EA EMPLOYE -
<br />1 ,000,000
<br />Iff yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE - POLICY LIWIL
<br />1,000,000
<br />I DESCRIPTION OF OPERATIONS f LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached It more space is required)
<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 (imitations
<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 Cancell'10 Days for Non- Payment in accordance with policy provisions.
<br />JOSEPH C. TPt,J AW & ASSC IATES: AGREEMENT # A-2014-100
<br />REVIEWED BY: . t.. �i'' - "' "'' _.. EUNICE HEREDIA (p9. 1 of 5)
<br />CERTIFICATE HOLDER CANCELLATION
<br />of Santa Ana, SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />City
<br />Its officers and employees THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />Attn: Purchasing Department
<br />20 Civic Center Plaza
<br />Santa Ana CA 92701 AUTHORIZED REPRESENTATIVE ai
<br />(AVC) Alicia K. Igram
<br />@ 1988 -2014 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD
<br />CER-T NO.:. 2.223'1) "'i1 1AVC) E.tcy T: -n. 111112X07➢. 7:5(:3(7 5S ^1 YPS'M Pa:9e 3. a= 5
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