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tflejIv <br />) h"m 2.`5C <br />. taa R� CERTIFICATE OF LIABILITY INSURANCE <br />`....-�" <br />D/9/2,16 <br />3/9/2016 <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 polloy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to <br />the terns 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 ondorsament s). <br />PRODUCER <br />Nickerson Insurance Services, Inc. <br />LIC #0491589 <br />2106 West Lomita Blvd. <br />Lomita CA 90717 <br />CON Ac Susan Hare <br />PNotae f310)_326_-6333 FAX (atm Ez6-sats <br />IArc. ry,4)i__ <br />ROIL` eusan@nickersordns. com <br />INSURER(S) AFFORDING COVERAGE NAICIt <br />INSURER A:Philadel hia Indemnity fns Co 18058. <br />INSURED <br />Thirdwave Corporation <br />11400 W Olympia Blvd #200 <br />Los Angeles CA 900 64-158 4 <br />INSURERS 'Mercury Casualty Company 11908 <br />INSURER C: <br />INSURER D: <br />INSURER E : <br />INSURER F: <br />lK�l'1R:2111�'�tl=10112[01-1111Ia 0111M:1a4O151i WA L9 red J111111"I 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 PAID CLAIMS. <br />TNSR <br />LT <br />TYPE OF IN SURMISE <br />POLICY NUMBER <br />POLICY EFF <br />MMI D <br />POLICY EXP <br />b <br />_ <br />LIMITS <br />eENERALLiABIUTY <br />EACH OCCURRENCE 3 2,000,0 0 <br />A <br />X COMMERCIAL GENERAL LIABILITY <br />CLAIMS -MAGE OCCUR <br />X <br />HSDIO78175 <br />0/24/2015 <br />0/24/2016 <br />RISES Ea cewnrenca $. 50,.000 <br />MED UP Wy ono enson) $ .5_,000 <br />PERSONAL&ADV INJURY $ 2,000,000 <br />GENERAL AGGREGATE 5 2,000,000 <br />GEN'LAGGREGATF. <br />LIMIT APPLIES PER'S• <br />PRODUCTS -COMPIOP AGO 5 2,000,000 <br />T POLICY <br />PRa LOC <br />S. <br />AUTOMOBILE <br />LIABILITY <br />EOeBINEDISINGLE LIMIT 1,000,000 <br />B <br />X <br />ANY AUTO <br />ALLOMED SCHEDULED <br />AUTOS AUTOS <br />CCA0008363 <br />- <br />/5/2016 <br />3/5/2017 <br />BODILY INJURY (Per penton) S <br />BODILY INJURY (Po.dant) 3 <br />HIRED AUTOS AUTOSMED <br />PROP RTY DAMAGE S <br />t onq.vftv audit S <br />X <br />UMBRELLALIAD <br />OCCUR <br />EACH OCCURRENCE S 11000,000 <br />AGGREGATE S. 1,000,000 <br />A <br />EXCESS LIAR <br />CLAIMS -MADE <br />DEC I I RETENTIONS <br />$ <br />PHUBS14514 <br />9/10/2015 <br />/10/2016 <br />WORKERS COMPENSAIRON <br />Sl'ATU OTH- <br />ANDEMPLOYERTLIABILITY YIN <br />ANY PROPRIE'rOPIPARTNERIEXECUTIVE <br />OFPICERIMEMBER EXCLUDED? E] <br />NIA- <br />I T <br />E.L. EACH ACCIDENT <br />E.L. DISEASE• EA&MPDOYE S- <br />(Mandst.ny In NH) <br />t yes, al"albe wdor <br />E.L. DISEASE -POLICY LIMIT $ <br />DESCRIPTION OF OPERATIONS below <br />A <br />Professional Liability <br />HSD10°!6175 <br />10/24/2015 <br />0/24/2016 <br />_ <br />$1,000, 000 <br />Each ClaimF1 <br />I <br />Aggregate $1,000,000 <br />DESCRIPnON OF OPERATIONS I LOCAnONS I VEHICLES (At ACORD 101, Additional Rentarlts Schodulo, 8 mare space Is mquimdi <br />City of Santa Ana, it officers, agents, and employees are hereby included as Additional Insureds on the <br />liability as respects to claims arising from the insureds covered operations per Additional Insured <br />Endorsement form PI-NANU-1 (01/00) and Businessowners Policy -Elite Enhancement form PI -PB -001 (9/05). 30 <br />days notice of cancellation subject to 10 days notice for non payment of Premium. <br />City of. Santa Ana <br />Attn: Purchasing Department <br />20 Civic Center Plaza <br />Santa Ana, CA 92701 <br />25 <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 />rinhho ruenrvaH <br />INS025 (minM) of Th. A(.nCln nom. anA lnnn Bra ranlotn'. 1 mor4c of Artr Rn r�t� <br />I A'C '7 <br />