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ACC?I?hP CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDNWY) 10/7/2016 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(les) 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 NAME: B b Bacon/Nancy Klucher Earl Bacon Agency, Inc. P.O. Box 12039 Tallahassee FL 32317 PHONE FAX No :850-878-212 EMAIL ADDRESS:bbac0 a a o c e baco INSUREI AFFORDING COVERAGE NAIL p Y INSURER A:Am rican Casualty Co. of Reading 7/1/2016 INSURED MGTOF-1 INSURER B:Cont rental Casualty Company 20443 INSURER C Nalley Fore Insurance Co. 20508 MGT of America, LLC MGT of America Consulting, LLC 3800 Esplanade Way, Ste 210 Tallahassee FL 32311 INSURER D:TRANSPORTATION SCO 4 INSURER E: r vele sCas.&Suret Coo e 1 94 INSURER F: COVERAGES CERTIFICATE NUMBER: 1424826367 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. INSR LTR TYPE OF INSURANCE O L INSR R MD POLICY NUMBER POLICY EFF MMIDDIYYYY POLICY EXP MMIODM/Yy LIMITS A GENERAL LIABILITY Y Y 5095130327 7/1/2016 7/1/2017 EACH OCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE IX I OCCUR D I E TO RE TED PREMISES flEa occurrence $300,000 MED EXP (Any one person) $5,000 PERSONAL & ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GENE AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $2,000,000 X` POLICY PRO-JECT LOC $ A AUTOMOBILE LIABILITY Y Y 2093563501 7/1/2016 7/1/2017 COMBSINGLE LIMIT INED 1,000,000 BODILY INJURY (Per person) $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Par eocld.nt) $ X X NON -OWNED HIREO AUTOS AUTOS PROPERTY DAMAGE $ Peracarunt $ X A -XV Rating B UMBRELLA LIAB OCCUR 2093563496 7/1/2016 7/1/2017 EACH OCCURRENCE S AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED RETENTION $ $ O D WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y/N y 3011086712 -All Other 3011086788 CA 7/1/2016 7/1/2016 7/1/2017 7/1/2017 X WC STATU- OTH- TORY LIMITS ER ANY PROPRIETORIPARTNERIEXECUTIVE❑ E.L. EACH ACCIDENT $500,000 OFFICERIMEMBER EXCLUDED? NIA E.L. DISEASE - EA EMPLOYEE $500,000 (Mandatory in NH) If yes, describe under DEa RIPTION OF OPERATIONS below EL.DISEASE - POLICY LIMIT $500,000 E Professional Liability(E&O) N N 105636880 7/1/2016 7/1/2017 Each Claim 2,500,000 Claims -Made Form Aggregate 3,000,000 7/5/95 Retro Date/A-XIV DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) Umbrella: A -XV Rating. All Other Workers' Comp & CA Workers' Comp: A -XV Rating. CA - Workers' Comp Employers Liability Limits: $1,000,000 Each Accident $1,000,000 Disease Policy Limit $1,000,000 Disease Each Employee City of Santa Ana 20 Civic Center Plaza (M-30) P.O. Box 1988 Santa Ana CA 92702-1988 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 © 1988.2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD