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<br />ALBERT GROVER & ASSOCIATES RFCA 10/21/15 PROJ 16 6861 REVIEWED BY: EUNICE HEREDIA (PG 1 OF 3)
<br />A� KC Is CERTIFICATE OF LIABILITY INSURANCE
<br />DA 1 „3/2915
<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 13 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 />NAMErC Beuv' ran
<br />PHONE FAX
<br />949 297-5962 IAIC Na: 949 -297 -5960
<br />e MAIL
<br />belt .tran ioausaCom
<br />Mae,
<br />INSURER(S) AFFORDING COVERAGE
<br />NAICA
<br />f
<br />INSURER A: RLI Insurance Com an
<br />13056
<br />www.ioausa.com CA License #OE67768
<br />INSURED
<br />Albert Grover & Associates, Inc.
<br />211 East Imperial Hwy, Suite 208
<br />Fullerton CA 92835
<br />INSURER B: RSUI Indemnity Company
<br />22314
<br />INSURERC: Continental Casualty Company
<br />20443
<br />INSURER D:
<br />INSURER E
<br />Scheduled Al Endt
<br />#PPB3130212
<br />Professional Services
<br />INSURER F;
<br />PREMSET Eaoccu''.nce
<br />$ 1,000,000
<br />COVERAGES CERTIFICATE NUMBER: 27174887 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 />ILTR
<br />TYPE OF INSURANCE
<br />INSD
<br />SUER
<br />POLICY NUMBER
<br />M1IMI��IYYYY
<br />POLICY IYYYY
<br />LIMITS
<br />A
<br />f
<br />COMMERCIAL GENERAL LIABILITY
<br />f
<br />f
<br />PSB0o01618
<br />7/1/2015
<br />7/112016
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />CLAIMS -MADE ❑✓ OCCUR
<br />Prlmary/Non- ContrlbutOr�__
<br />–
<br />Scheduled Al Endt
<br />#PPB3130212
<br />Professional Services
<br />PREMSET Eaoccu''.nce
<br />$ 1,000,000
<br />f
<br />WED EXP(Aaone pem °n)
<br />—
<br />$ 10000
<br />f
<br />I Waiver of Subrogation
<br />PERSONAL d ADV INJURY
<br />$ 1,000,000
<br />performed by the Insured
<br />AGGREGATE LIMIT APPLIES PER
<br />GENERAL AGGREGATE
<br />$ 2,000,000
<br />GEN'L
<br />are Excluded
<br />POLICY [Z] Or ❑ LOC
<br />PRODUCTS AGO
<br />$ 2,OOQ000
<br />$
<br />H '.
<br />OTER
<br />A
<br />AUTOMOBILE
<br />LIABILITY
<br />ANYAUTO
<br />ALL OWNED SO FOULED
<br />AUTOS AUTOS
<br />PSB0001618
<br />Included In General
<br />Liability
<br />711/2015
<br />7/112016
<br />�1ONGLE LIMIT
<br />$ _ 0010 000
<br />BODILY INJURY (Pe, pure.,)
<br />$
<br />BODILY INJURY (Per accitlenQ
<br />$
<br />NON -OWNED
<br />HIRED AUTOS AUTOS
<br />PROPERTY DAMAGE
<br />IPeramdonl
<br />$
<br />$
<br />B
<br />UMBRELLA UAB
<br />f
<br />OCCUR
<br />NHA233176
<br />7/1/2015
<br />771/2016
<br />EACH OCCURRENCE
<br />$ 2 ,000000
<br />f
<br />EXCESS LIAB
<br />CLAIMS MADE
<br />Excludes Professional
<br />Liability; Follow Form
<br />AGGREGATE
<br />$ 2,000,000
<br />oED RETENTION$
<br />—
<br />5
<br />A
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY YIN
<br />ANYPROPRIETORIPARTNEILEXECUTIVE
<br />OFFICERIMEMBER EXCLUDED? (]
<br />(Mandatary in NH)
<br />NIA
<br />f
<br />P3W0001494
<br />Waiver of Subrogation
<br />Endt #WC0403060484
<br />7/1/2015
<br />7/1/2016
<br />f STATUTE aRH
<br />_
<br />E.L. EACH ACCIDENT
<br />__
<br />$ 1,000,000
<br />E. L. DISEASE EA EMPLOYE
<br />$ 1,000,000
<br />f yee. daac,ibe Under
<br />DESCRIPTION OF OPERATIONS below
<br />E.I.. DISEASE - POLICY LIMIT
<br />$ 1,000,000
<br />C
<br />Professional Liability
<br />MCH288354455
<br />711/2015
<br />71112016
<br />$2,000,000 Each Claim
<br />Claims -Made
<br />$4,000,000 Aggregate
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORO 101, Additional Ramarke Schedule, ,nay be atWCM1ed it moro apaw Is required)
<br />Certificate Holder is an Additional Insured with respect to General Liability (GL but only when required by written contract with the Insured prior
<br />to an occurrence as per Endorsement noted above. GL includes Separation o Insureds and Contractual Liability per limitations in the BusinessOwners'
<br />Coverage form. A Workers Compensation Waiver of Subrogation as noted above is included for the person or organization named in the Schedule
<br />that are parties to a contract requiring this Endorsement, provided that contract is executed before the loss. Coverage subject to all policy terms
<br />conditions, limitations and exclusions. 30 Day Notice Cancellation110 Days for Non - Payment in accordance with policy provisions.
<br />CERTIFICATE HOLDER CANCELLATION
<br />Speed Survey 2015
<br />City f Santa Ana
<br />Y
<br />its officers, employees, and representatives
<br />PO Box 1988
<br />SHOULD ANYOF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />20 Civic Center Piz, M -93
<br />Santa Ana CA 92702
<br />---
<br />AUTHORIZED REPRESENTATIVE
<br />(AVC) Alicia K. Igran,
<br />©1988 -2014 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD
<br />2” _7tee-r i. 7 l L P—I n= L -- ?Lev 1 11f 15 1 -_2,42 I _ 1 ,2 ]
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