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AC40R& CERTIFICATE OF LIABILITY INSURANCE
<br />I`I, /
<br />DATE(MMIDDIYYYY)
<br />10/15/2015
<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 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 Tech Serve Alliance Services Corp.
<br />1420 King Street; Suite 610
<br />Alexandria, VA 22314
<br />CONTACT
<br />PHONE FAX
<br />E 703- 997 -4271 AC No: 703.997.7727
<br />EMAIL
<br />ADDRESS:
<br />INSURERS) AFFORDING COVERAGE
<br />NAIC N
<br />✓
<br />INSURER A: Star Insurance Company
<br />NDA0791984
<br />wWw.techservealliance.org
<br />INSURED
<br />Comdyn Group Inc., The
<br />100 E. Thousand Oaks Blvd.
<br />INSURER B: ProCentury Insurance Company
<br />$ 1,000,000
<br />INSURER C:
<br />TCOMMERCIAL
<br />CLAIMS -MADE ❑✓ OCCUR
<br />INSURER 0: National Specialty Insurance Company
<br />Suite 284
<br />Thousand Oaks CA 91360
<br />NSURER E:
<br />NN URER F:
<br />$ 1,000,000
<br />CnVFRAfIFS CFRTIFICATF NIIMRFR• rRDMTIR RFVLCIr11d NIIMRPR.
<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 />LTR
<br />TYPE OF INSURANCE
<br />ADDL
<br />SUD
<br />POLICY NUMBER
<br />MMIDOY�
<br />POLICY -mc
<br />LIMITS
<br />D
<br />GENERAL LIABILITY
<br />✓
<br />NDA0791984
<br />6/15/2015
<br />6/15/2016
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />TCOMMERCIAL
<br />CLAIMS -MADE ❑✓ OCCUR
<br />PREMISES Ea occurrence
<br />$ 1,000,000
<br />MED EXP (Any one person)
<br />$ 10,000
<br />PERSONAL B ADV NJURY
<br />$ 1,000,000
<br />GENT AGGREGATE LIMIT APPLIES PER
<br />GENERAL AGGREGATE
<br />$ 2,000,000
<br />✓ POLICY D JECOT LOG
<br />PRODUCTS COMP /OP AGG
<br />$ 2,000,000
<br />$
<br />OTHER:
<br />D
<br />AUTOMOBILE
<br />LIABILITY
<br />✓
<br />NDB0791984
<br />6/15/2015
<br />6/15/2016
<br />COMBINED SINGLE LIMIT
<br />Ea accident
<br />$ 1,000,000
<br />BODILY INJURY (Per person)
<br />$
<br />ANYAUTO
<br />ALL OWNED SCHEDULED
<br />AUTOS AUTOS
<br />BODILY INJURY (Per accident)
<br />$
<br />✓
<br />NON -OWNED
<br />HIRED AUTOS ✓ AUTOS
<br />PROPERTY DAMAGE
<br />Peraccidenl
<br />$
<br />A
<br />,/
<br />UMBRELLA LIAR
<br />,/
<br />OCCUR
<br />✓
<br />UM0791984
<br />6/15/2015
<br />6/15/2016
<br />EACH OCCURRENCE
<br />$ 1000000
<br />AGGREGATE
<br />$ 1,000,000
<br />EXCESS LIAR
<br />CLAIMS -MADE
<br />DED ✓ RETENTION $10,000
<br />$
<br />B
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY
<br />ANY PROPRIETORIPARTNERIEXECUTIVE YIN
<br />OFFICEWMEMBER EXCLUDED?
<br />NIA
<br />WC0791984
<br />6115/2015
<br />6/15/2016
<br />✓ STATUTE aRH
<br />E.L. EACH ACCIDENT
<br />$ 1,000,000
<br />E.L. DISEASE - EA EMPLOYEf
<br />$ 1,000,000
<br />(Mandatory In NH)
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE - POLICY LIMIT
<br />$ 1,000,000
<br />D
<br />E &O /Professional Liab
<br />✓
<br />NDA0791984
<br />6/15/2015
<br />6/15/2016
<br />1$1,000,000 Ea Claim /$1,000,000 Aggregate
<br />A
<br />Crime - 3rd Party Blanket
<br />CR0791984
<br />6/15/2015
<br />6/15/2016
<br />$25,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS IVEH ICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is rminlred)
<br />City of Santa Ana, its Officers, Agents and Employees are Additional Insured as respects to General Liability
<br />per attached CG2010 1093 Additional Insured Endorsement. Should any of the above described policies be cancelled or reduced before the expiration
<br />date thereof, the issuing insurer and /or agent will endeavor to mail 30 days written notice the the Certificate Holder, but failure to do so shall
<br />impose no obligation or liability of any kind upon the insurer, its agents or representatives.
<br />■"Rilll>tlLl�
<br />Cif of Santa Ana, SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />Y THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />its Officers, Agents, and Employees ACCORDANCE WITH THE POLICY PROVISIONS.
<br />20 Civic Center Plaza
<br />Santa Ana CA 92702 AUTHORIZED REPRESENTATIVE
<br />Mark B. Roberts
<br />©1988.2014 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD /}� j r
<br />26942735 I Comdyn Inc 15 -16 Aporoval Certificate I dill Norton 1 10/15/2015 2:51:11 PM (EDT) I Page 1 of 2
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