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la. ./' i P CERTIFICATE OF LIABILITY INSURANCE
<br />fir
<br />0111/,DDIY
<br />6/11/2015
<br />5
<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
<br />BayPoint Benefits
<br />Montgomery Street
<br />Suite 240
<br />San Francisco CA 94111
<br />CON ACT Joel Starke
<br />A
<br />HONE (141,1)520-1080 FAi6iX
<br />1700
<br />aooAles'.Joe. et arkeebaypointbenefits.com
<br />INSURERS AFFORDING COVERAGE NAIC0
<br />INSURER A: Travelers Indemnity CO 25666
<br />INSURED
<br />Nelson/Nygaard Consulting Associates, Inc
<br />116 NEW MONTGOMERY ST STE 500
<br />SAN FRANCISCO CA 94105
<br />INSURER B:Sentinel Insurance Company LTD 11000
<br />INSURER C:Continental Casualty Company 20443
<br />INSURER D:
<br />INSURER E:
<br />INSURER F:
<br />COVERAGES - CERTIFICATE NUMBER:CL1561102233 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 />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />INTR
<br />rypE OFINSURANCE
<br />POLICY NUMBER
<br />POLIC EFF
<br />POLICY EXP
<br />LIMITS
<br />GENERAL LIABILITY
<br />EACH
<br />OCCURRENCE $ 2,000,000
<br />X COMMERCIAL GENERAL LIABILITY
<br />680-SF210211
<br />1/29/2015
<br />9/1/2015
<br />PREMISES'M. occurrence) $ 1,000,000
<br />A
<br />C1AIMS4ADE OCCUR
<br />X
<br />680-58209144
<br />1/29/2015
<br />9/1/2015
<br />MED EXP (Any one person) $ 10,000
<br />PERSONAL B ADV INJURY $ 2,000,000
<br />GENERAL AGGREGATE S 4,000,000
<br />GEN'L AGGREGATE
<br />LIMIT APPLIES PER:
<br />PRODUCTS - COMP/OP AGG $ 4,000,000
<br />POLICY
<br />X PRO LOC
<br />$
<br />AUTOMOBILE
<br />LIABILITY
<br />EO aB ED o an
<br />ot)SINGLE LIMIT 1,000,000
<br />BODILY INJURY (Per person) $
<br />AANY
<br />AUTO
<br />BODILY INJURY
<br />ALL OWNED SCHEDULED
<br />A -5F339590
<br />1/29/2015
<br />9/1/2015
<br />AUTOS AUTOS
<br />X
<br />(Par accident) $
<br />X
<br />X NON -OWNED
<br />PROPERTY DAMAGE
<br />HIRED AUTOS AUTOS
<br />eraccldenl $
<br />$
<br />X
<br />UMBRELLA UAB
<br />FX
<br />TO;...
<br />UP-OOSF2195B0
<br />1/29/2015
<br />9/1/2015
<br />EACH OCCURRENCE $ 4,000,000
<br />AGGREGATE $ 4,000,000
<br />A
<br />EXCESSLIAB
<br />CLAIMS -MADE
<br />'EDRETENTIO 10,00
<br />$
<br />B
<br />WORKERS COMPENSATION
<br />X WCSTATU. OTH.
<br />AND EMPLOYERS' LIABILITY
<br />ANY PROPRIETOWPARTNEWEXECUTIVE YIN
<br />57 WEC PF8365
<br />9/1/2019
<br />9/1/2015
<br />E.L. EACH ACCIDENT $ 11000,000
<br />A
<br />OFPICERIMEMBER EXCLUDED?
<br />(Mandatory In NH)
<br />NIA
<br />8-4393T67
<br />1/29/2015
<br />9/1/2015
<br />E.L. DISEASE - EA EMPLOYEE .$ 1,000,000
<br />It yes, describe under
<br />E.L. DISEASE -POLICY LIMIT $ 11000,000
<br />DESCRIPTION OF OPERATIONS below
<br />C
<br />Professional LiabilityCH591867501
<br />12/1/2014
<br />12/1/2015
<br />par Clalm 5,000,000
<br />Deductible $50,000
<br />Annual Aggregrate 5,000,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is required)
<br />Those usual to the insured's operations. City of Santa Ana, 20 Civic Center Plaza, Santa Ana, California
<br />92701; its officers, employees, agents, volunteers and representatives are covered as additional insured
<br />per the Business Liability Form CG D3 82 09 07 and the Auto Liability Coverage Form CA T3 53 03 10
<br />attached to this policy. Coverage is primary & non-contributory per the/ Bu iness Liability Coverage Porm
<br />CG D3 82 09 07 attached to this policy.
<br />NELSON/NYGAARD CONSULTING ASSOCIATES, INC AGR# TBD REVIEWED SY: EUNICE HEREDIA (PG 1 OF 7
<br />City of Santa Ana
<br />20 Civic Center Plaza
<br />Santa Ana, CA 92701
<br />ACORD 25 (2010/05)
<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 />Joel Starke/JOELS-�'--`z- ---J��"—"'---
<br />O 1988.201
<br />INS02512ntnnsl w The AClTRD name anH In are ron i.fcroA mark. of Ar.nPn
<br />reserved
<br />
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