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A� " CERTIFICATE OF LIABILITY INSURANCE
<br />ATE
<br />D3/29/2017 )
<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(les) 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
<br />Shaw Moses Mendenhall & Associates Ina. Agency
<br />License #OD94511
<br />625 Fair Oaks, Suite 158
<br />South Pasadena CA 91030
<br />CONTACT NAME; Xanh (Sand) Tran
<br />PHONE 626)799-7813 FAC. No: (626)'199-8784
<br />E-MAIL xanh(®ammainsurance.com
<br />AOORES5:
<br />INSURERS AFFORDING COVERAGE
<br />NAIC9
<br />INSURER A:Citi Zens Insurance Company of
<br />31534
<br />INSURED
<br />COLANTUONO, HIGHSMITH Be
<br />WHATLEY, PC.
<br />420 SIERRA COLLEGE DR. STE 140
<br />GRASS VALLEY CA 95945
<br />INSURER B:EVans ton Insurance Company
<br />COMMERCIAL GENERAL LIABILITY
<br />INSURERC:
<br />INSURER D:
<br />INSURER E:
<br />EACH OCCURRENCE $ 2,000,000
<br />1 INSURER F:
<br />CLAIMS -MADE FX OCCUR
<br />COVERAGES CERTIFICATE NUMBER:CL1732905990 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 />SANTA ANA, CA 92702
<br />BR
<br />POLICY NUMBER
<br />POLICY EFF
<br />MMDD/YYYY
<br />POLICY EXP
<br />MMDD
<br />LIMITS
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />EACH OCCURRENCE $ 2,000,000
<br />A
<br />CLAIMS -MADE FX OCCUR
<br />DAMAGERENTED 300,000
<br />PREMISESS Ea occurrence $
<br />MED EXP (Any one person) $ 5,000
<br />0339898667
<br />4/1/2017
<br />4/1/2018
<br />PERSONAL &ADV INJURY $ 2,000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />GENERAL AGGREGATE $ 4,000,000
<br />POLICY❑PRO- LOC
<br />X JECT
<br />PRODUCTS-COMP/OPAGG $ 4,000,000
<br />Employee Benefits $ 1,000,000
<br />OTHER:
<br />AUTOMOBILE
<br />LIABILITY
<br />CEaOMBINED SINGLE LIMIT
<br />accident $ 2,000,000
<br />BODILY INJURY (Par person) $
<br />AANY
<br />AUTO
<br />ALL OWNED SCHEDULED
<br />AUTOS AUTOS
<br />OB39898667
<br />4/1/2017
<br />4/1/2018
<br />BODILY INJURY (Per accident) $
<br />]C
<br />NON -OWNED
<br />HIRED AUTOS ]C AUTOS
<br />PROPERTY DAMAGE
<br />Per accident $
<br />A
<br />X
<br />UMBRELLA LIAB
<br />OCCUR
<br />OB39898667
<br />04/01/2017
<br />04/01/2018
<br />EACH OCCURRENCE $ 3,000,000
<br />AGGREGATE $ 3,000,000
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />DED RETENTION
<br />$
<br />WORKERS COMPENSATIONX
<br />AND EMPLOYERS' LIABILITY YIN
<br />PER 0TH -
<br />STATUTE ER
<br />E.L. EACH ACCIDENT $ 1,000,000
<br />A
<br />ANY PROPRIETOR/PARTNEWEXECUTIVE❑NIA
<br />OFFICERIMEMBER EXCLUDED?
<br />(Mandatory in NH)
<br />W1339898674
<br />4/1/2017
<br />4/1/2018
<br />E.L. DISEASE - EA EMPLOYE $ 11000,000
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS be.
<br />E.L. DISEASE -POLICY LIMIT $ 1,000,000
<br />B
<br />Professional Liability
<br />LA808794
<br />4/4/2017
<br />4/4/2018
<br />2,000,000/4,000,000
<br />25,000 deductible
<br />DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
<br />CERTIFICATE HOLDER IS AN ADDITIONAL INSURED AS RESPECTS GENERAL LIABILITY FOR WORK PERFORMED BY NAMED
<br />INSURED
<br />CERTIFICATE HOLDER CANCELLATION
<br />ACORD 25 (2014/01)
<br />INS025 (201401)
<br />©1988.2014 ACORD CORPORATION. All rights reserved.
<br />The ACORD name and logo are registered marks of ACORD
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />CITY OF SANTA ANA
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />20 CIVIC CENTER PLAZA 7TH FL
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />SANTA ANA, CA 92702
<br />AUTHORIZED REPRESENTATIVE
<br />Xanh (Sand) Tran/XTT
<br />ACORD 25 (2014/01)
<br />INS025 (201401)
<br />©1988.2014 ACORD CORPORATION. All rights reserved.
<br />The ACORD name and logo are registered marks of ACORD
<br />
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