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AC "RUB CERTIFICATE OF LIABILITY INSURANCE
<br />ATE (MM/DDYYYY)
<br />r
<br />�,
<br />9/15/2016
<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 have ADDITIONAL INSURED provisions or be endorsed.
<br />If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on
<br />this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
<br />PRODUCER Asero Insurance Services
<br />200 N. Almaden Blvd. 3rd Floor
<br />San Jose, CA 95110
<br />NAME: Asero Insurance Services
<br />PHONE — FAX
<br />-fA_IC-No Ext) _ 866-966-8928 (A/C,No): 408-271-1802
<br />E-MAIL
<br />ADDRESS: certS@aserolns.com
<br />INSURER(S) AFFORDING COVERAGENAIC #_
<br />INSURER A: Travelers Property Casualty Co of Amer 25674
<br />www.aseroins.com _ License No 0A91339
<br />INSURED
<br />Mark Thomas & Company, Inc.
<br />2290 North First Street, Sulte 304
<br />INSURER B : Travelers Indemnity Company of CT 25682
<br />INSURERC:
<br />_—
<br />INSURERD:
<br />San Jose CA 95131
<br />INSURER E
<br />INSURER F :
<br />WK01T=011ATell NAd9IsrNerl;11111dlild4a;a: I:kyjW1`1111111011111iLy,I
<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 CLAIMS.
<br />INSR
<br />LTR
<br />TYPE OF INSURANCE
<br />ADOL
<br />INSD
<br />SUBRPOLICY
<br />WVD
<br />POLICY NUMBER
<br />MMIDD YYYYMM/DDYYYY
<br />`PAID
<br />EXP
<br />LIMITS
<br />A
<br />✓ COMMERCIAL GENERAL LIABILITY
<br />�/
<br />/
<br />680-21-1548914
<br />9/15/2016
<br />9/15/2017
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />CLAIMS -MADE �✓ OCCUR
<br />PREM SES (Ea occurrence)
<br />$ 1,000,000
<br />MED EXP (Any one person)
<br />$ 10,000
<br />PERSONAL & ADV INJURY
<br />$ 1,000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />GENERAL AGGREGATE
<br />2,000,000
<br />POLICYLV] JE� �� LOC
<br />_
<br />PRODUCTS,_COMP/OPAGG
<br />_$
<br />$- 2,000,000
<br />----------- -----
<br />OTHER:
<br />B
<br />AUTOMOBILE LIABILITY
<br />BA-6H189707
<br />9/15/2016
<br />9/15/2017
<br />C MBINEDtSINGLE LIMIT
<br />$ 10001000
<br />BODILY INJURY (Per person)
<br />$
<br />✓ ANY AUTO
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />BODILY INJURY (Per accident)
<br />$
<br />✓ ''; HIRED NON -OWNED
<br />AUTOS ONLY ✓ AUTOS ONLY
<br />PROPERTY DAMAGE
<br />{Per accident)
<br />$
<br />$
<br />✓ 500 CompDe . ✓ 1,000 Coll Ded.
<br />A
<br />/ '... UMBRELLA LIAB
<br />✓
<br />occuR
<br />CUP009EO95562
<br />9/15/2016
<br />9/15/2017
<br />EACH OCCURRENCE
<br />$ 4,000,000
<br />AGGREGATE
<br />$ 4,000,000
<br />'I EXCESS LIAB
<br />CLAIMS -MADE
<br />DED RETENTION $
<br />$
<br />A
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY
<br />ANYPROPRIETOR/PARTNER/EXECUTIVE —Y/N
<br />OFFICER/MEMBER EXCLUDED?
<br />NIA
<br />✓
<br />XJUB4342T25016
<br />9/15/2016
<br />9/15/2017
<br />,/ (STATUTE �RH
<br />---- --
<br />E.L. EACH ACCIDENT
<br />----
<br />$ 1,000,000
<br />----------
<br />E.L. DISEASE - EA EMPLOYEE
<br />---
<br />$ 1,000,000
<br />(Mandatory in NH)
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />-----
<br />E.L. DISEASE - POLICY LIMIT
<br />----
<br />$ 1,000,000
<br />DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
<br />Job #IR-15103 On -Call Engineering Services
<br />The City of Santa Ana, its officers, employees, agents, volunteers and representatives
<br />NOTE: 30 DAYS NOTICE OF CANCELLATION WILL BE GIVEN EXCEPT 10 DAYS FOR NON-PAYMENT.
<br />REVIEWED BY, I UNIT F ! EREDIA (PG OF �� )
<br />CERTIFICATE HOLDER CANCELLATION
<br />City of Santa Ana
<br />20 Civic Center Plaza
<br />Santa Ana CA 92702
<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 />Joe Longwello
<br />@ 1988.2015 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
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