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249359 <br />A f�i0 DATE 21 /20 FYYYYI <br />'�.! CERTIFICATE OF LIABILITY INSURANCE 4r2.1izQ1s <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. THIIS 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 ondorsoment(s). <br />PRODUCER <br />CONTACT Traci Williams <br />NAME: <br />Wells Fargo Insurance Services USA, Inc. <br />PHONE . 916 589 -8170 c NI I: 877 403-7193 <br />ADDRESS: traCl.d.WllllamS Wellsfar O °COm .__. <br />E -MAIL <br />__.. <br />INSURER(S) AFFORDING COVERAGE <br />NAIC # <br />10940 White Rock road, 2nd Floor <br />Rancho Cordova, CA 95670 <br />INSURER A: National Surety Corporation <br />21881 <br />INSURED <br />INSURER B: Cypress insurance Company <br />10855 <br />Macias Gini & O'Connell LLP <br />INSURER C: <br />PERSONAL & ACV INJURY <br />Macias Consulting Group & <br />INSURER D: <br />$ 4,000,000 <br />Intellibridge Partners LLC <br />3000 $ SL Ste 300, Sacramento, CA 95816 o15 _ n <br />INSURER E: <br />INSURER F <br />'... A <br />COVERAGES CERTIFICATE NUMBER: 9033244 REVISION NUMBER: See below <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 />SUER <br />Wvp <br />POLICY NUMBER <br />POLICY EFF <br />(M.M.1.D.DNYY'YI <br />POLICY EXP <br />IMMIDDffYYYl <br />...° <br />LIMITS <br />A <br />X <br />COMMERCIAL GENERAL LIABILITY <br />� OCCUR <br />CLAIMS -MADE L�J <br />AGGREGATE LIMIT APPLIES PER <br />POLICY T E LOC <br />OTHER: <br />AZC80903390 <br />04!30!2015 <br />04/3012016 <br />EACH OCCURRENCE <br />$ 2,000,000 <br />'.. GEN'L <br />X <br />RENTED <br />DAMAGES (Ea occuence <br />PREMISES rr �' <br />$ 100 000 <br />MED EXP (Any one person) <br />$ 10,000 <br />PERSONAL & ACV INJURY <br />$ 2, ©00,000 <br />GENERAL AGGREGATE <br />$ 4,000,000 <br />PRODUCTS - COMPIOP AGG <br />$ 4,UUU,ODU <br />$ <br />'... A <br />AUTOMOBILE <br />� <br />X <br />LIABILITY <br />ANY AUTO <br />ALL OWNED SCHEDULED <br />AUTOS UT S <br />AO <br />NCN -7WNED <br />HIRED AUTOS x AUTOS <br />No Owned Au <br />AZC80903390 <br />04/30/2015 <br />04/30/2016 <br />COMBINED SINGLE. LIMIT <br />jEa accident <br />$ 2,000,000 <br />BODILY INJURY (Per person) <br />$ <br />BODILY INJURY (Per accident) <br />$ <br />P c�a cid Y AMAGE <br />$ <br />A <br />X <br />UMBRELLA LIAR <br />EXCESS ILIAB <br />X <br />OCCUR <br />CLAIMS -MADE <br />AZC80903390 <br />0413012015 <br />04/3012016 <br />EACH OCCURRENOE <br />$ 2,000,000 <br />AGGREGATE <br />$ 2,000,000 <br />DED X RETENTION $ 0 <br />$ <br />B <br />WORKERS COM PEN '.SATION <br />AND EMPLOYERS " LIABILITY YIN <br />ANY PROPRIETOWPARTNERIEXECUTIVE <br />OFFIC£RfMEMBEREXCLUDED ?' ® <br />(Mandatory in NH) <br />If yes, describe under <br />DESCRIPTION OF OPERATIONS below <br />NIA <br />MAWC602569 <br />04/30/2015 <br />94/30/2016 <br />x S1EfATUTE ORTH <br />'ER <br />E.L. EACH ACCIDENT <br />S 1,000,000 <br />E.L. DISEASE - EA EMPLOYEE <br />S 1,.000,000 <br />E.L. DISEASE - POLICY LIMIT <br />$ 9,000,000 <br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 1 01, Additional Remarks Schedule, may be attached If more space is required) <br />RE:Audit Work performed on behalf of the certificate holder - Certificate holder is named additional insured per the attached AB 9189 08/07 form. <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 />20 Civic Center Plaza <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />Santa Ana, CA 92701 <br />AUTHORIZED REPRESENTATIVE <br />The ACORD name and logo are registered marks of ACORD @ 1988 -2014 ACORD CORPORATION, Ali rights reserved. <br />ACORD 25 (2014101) II'Z&I ' h t.l".rt1'i9r"l <br />. <br />02- <br />