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ACG RbP CERTIFICATE OF LIABILITY INSURANCE
<br />NSURANCE
<br />�.. ►^' �
<br />-
<br />P��1 MM /DDIYYYY)
<br />11/3/2015
<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 IOA Insurance Services
<br />130 Vantis, Suite 250
<br />Aliso Viejo, CA 92656
<br />CONTACT
<br />NAME: Betty Tran
<br />PHONE FAX
<br />Ex ' 949- 297 -5962 A/C No: 949 297 -5960
<br />E MAIL
<br />ADDRESS: bett .tran ioausa.com
<br />INSURERS AFFORDING COVERAGE
<br />NAIC #
<br />COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE ❑✓ OCCUR
<br />Prim /NonCon
<br />INSURER A: RLI Insurance Company
<br />13056
<br />www.ioausa.com CA License #OE67768
<br />INSURED
<br />Josepph C. Truxaw and Associates, Inc.
<br />265 S. Anita, Suite 111
<br />INSURER B:
<br />EACH OCCURRENCE
<br />INSURER C
<br />INSURER D
<br />$ 1,000,009
<br />Orange CA 92868
<br />INSURER E:
<br />$ 10,000
<br />✓
<br />INSURER F:
<br />PERSONAL & ADV INJURY
<br />$ 1,000,000
<br />GUVtKAUt5 GtK 11FIGAI E NUMBER: 9717RF7F RFVIStI()N NII IMRFR.
<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 />IN SD
<br />SUBR
<br />WVD
<br />POLICY NUMBER
<br />POLICY EFF
<br />MM /DD/YYYY
<br />POLICY EXP
<br />MM /DD/YYYY
<br />LIMITS
<br />A
<br />V
<br />COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE ❑✓ OCCUR
<br />Prim /NonCon
<br />✓
<br />✓
<br />PSB0001259
<br />Scheduled AIEndt
<br />#PPB313nal S
<br />Professional Services
<br />10/31/2015
<br />10/31/2016
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />DAMAGE
<br />$ 1,000,009
<br />✓
<br />MED EXP (Any one person)
<br />$ 10,000
<br />✓
<br />Wvr of Subr
<br />PERSONAL & ADV INJURY
<br />$ 1,000,000
<br />performed by the Insured
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />POLICY P/ E � ✓/ LOC
<br />GENERAL AGGREGATE
<br />$ 2,000,000
<br />are Excluded
<br />PRODUCTS - COMP /OP AGO
<br />$ 2,000,000
<br />$
<br />OTHER:
<br />A
<br />AUTOMOBILE
<br />LIABILITY
<br />ANY AUTO
<br />ALL OWNED SCHEDULED
<br />AUTOS AUTOS
<br />NON -OWNED
<br />HIRED AUTOS ✓ AUTOS
<br />✓
<br />✓
<br />PSA0001069
<br />Designated Insured Endt
<br />#CA20481013; Prim /NonCon
<br />and Blkt Wvr of Subr
<br />included on pg 2 of Form
<br />10/31/2015
<br />10/31/2016
<br />COMBINED SINGLE LIMIT
<br />Ea accident
<br />$ 1,000,000
<br />✓
<br />BODILY INJURY (Per person)
<br />$
<br />Per accident BODILY INJURY
<br />(Per
<br />$
<br />✓
<br />PROPERTY DAMAGE
<br />Per accident
<br />$
<br />✓
<br />$
<br />rim /NonCon ✓ Wvr of Subr
<br />#PPA3000313
<br />A
<br />UMBRELLA LIAB
<br />H
<br />OCCUR
<br />PSE0001215
<br />10/31/2015
<br />10/31/2016
<br />EACH OCCURRENCE
<br />$ 5,000,000
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />Excludes Professional
<br />Liability; Follow Form
<br />AGGREGATE
<br />$ 5,000,000
<br />DED RETENTION $
<br />$
<br />A
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY Y I N
<br />ANY PROPRIETOR /PARTNER /EXECUTIVE
<br />OFFICER/MEMBER EXCLUDED? ❑Y
<br />N / A
<br />✓
<br />PSW0001252
<br />Waiver Of Subrogation
<br />Endt #WC0403060484----
<br />10/31/2015
<br />10/31/2016
<br />�/ STATUTE EERH
<br />E.L. EACH ACCIDENT
<br />$ 1,000,000
<br />E.L. DISEASE - EA EMPLOYEE
<br />$ 1,000,000
<br />(Mandatory in NH)
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE - POLICY LIMIT
<br />$ 1,000,000
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if 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 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 -pay tin accordance with policy provisions.
<br />w_ �_..._..Y.__ �.......m _ f1Nl(E I1:GtIC)Ilk (Pt t:b_
<br />i � nvw"rX
<br />City of Santa Ana,
<br />its officers and employees
<br />20 Civic Center Plaza
<br />Santa Ana CA 92701
<br />I3T7 ViL2�LRL1■LVAV
<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 />(AVC) Alicia K. ]gram
<br />©1988 -2014 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD
<br />27178675 1 10/15 -16 GL /AUTO /EXCESS /WC I Patty Felker 1 11/3/2015 3:53:05 PM (PST) I Page 1 of 5
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