THIRDWAVE CORPORATION (2) - 2016

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AC40R& CERTIFICATE OF LIABILITY INSURANCE F .ATE(MM/DD/YYYY) 10/25/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Susan Haro NAME: Nickerson Insurance Services, Inc. LIC #0491589 PHONE (310) 326-6333 FAX (310)326-5916 �AIC. No Ext)' No): __ __ E-MAIL ADDRESS: susan@nickersonins.com 2106 West Lomita Blvd. INSURER(S) AFFORDING COVERAGE NAIC# INSURERA:Philadelphia Indemnit Ins Co 18058 Lomita CA 90717 INSURED Thirdwave Corporation INSURERB:Mercur Casualt Com an 11908 INSURER C: -- 11400 W Olympic Blvd #200 -- �- INSURER D: - - INSURER E: --....._...........------- PREMISES Ea occurrence Los Angeles CA 90064-1584 --....._..........._..--------- -------..............-----------------..._...... 1 INSURER F: --- COVERAGES CERTIFICATE NUMBER:16-17 GL/AUTO/UMB/PL REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. XDDL SR __ _--... _.__-- --__.... _ INSR _ ....._.----___ ._........_..IUB POLICY EFF... POLICY EXP,. ............... „ _.......... ,... ,...... ...... LTR TYPE OF INSURANCE POLICY NUMBER MM/DD/YYYYI (MMIDD/YYYYI LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000 A � CLAIMS X,� _ _ DAMAGE TO RENTED -- --- -MADE L OCCUR PREMISES Ea occurrence $ 50,000 X PHSD1179283 10/24/2016 10/24/2017 MED EXP (Any one person) $ 5,000 .._LOC PERSONAL&ADV INJURY .._...... $ 2,000,000 N'POLICREGATE LIMIT APPLIES PER: GENERAL AGGREGATE ..__.. $ 2,000,000 X Y D PRO- � JECT �-- - ..-- PRODUCTS - COMP/OP AGG --- — — $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY ',i COMBINED SINGLE LIMIT $ 1,000,000 B ANY AUTO BODILY INJURY Per parson) $ JX ALL OWNED SCHEDULED AUTOS CCA0008363 3/5/2016 3/5/2017 11 11 -"' """AUTOS BODILY INJURY (Pei accident) $ HIRED AUTOS NON -OWNED AUTOS AUTOS i _(Per accident ............ ...._.__.....— Longevity credit _._._. _.._..... $ 10 XIUMBRELLA -- LIAB OCCUR EACH OCCURRENCE $ 11000,00.0__ AGGREGATE _ $ 1, 000,00o A EXCESS LIAB j CLAIMS -MADE DED RETENTION$ PHUB560575 �10/24/2016 11/24/2017 WORKERS COMPENSATIONPER OTH- AND EMPLOYERS' LIABILITY Y / N --._STATUTE ER__.--__.._._.�.._.....__..__.___.___.... _.._. _. ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.E..A-CH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L. DISEASE - EA EMPLOYE $ If yes, describe under ------------- DESCRIPTION OF OPERATIONS below ! E.L. DISEASE - POLICY LIMIT $ A I Professional Liability PHSD1179283 10/24/2016 10/24/2017 Each Claim $1,000,000 Retro Date: 09/02/1997 Aggregate $1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) City of Santa Ana, it officers, agents, and employees are hereby included as Additional Insureds on the liability as respects to claims arising from the insureds covered operations per Additional Insured Endorsement form PI-MANU-1 (01/00) and Businessowners Policy -Elite Enhancement form PI -PB -001 (9/05). 30 days notice of cancellation subject to 10 days notice for non payment of premium. REVIEWED BY EUNICE �OEREDiAm(I�C f OF )�� nr—lL. Lucre 1,1AIV1,CLLA I IUIV City of Santa Ana Attn: Purchasing Department 20 Civic Center Plaza Santa Ana, CA 92701 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Sarah Kelly/SH (U 1UBB-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD INS025 r9m4m i