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A? " CERTIFICATE OF LIABILITY INSURANCE DATE (MWODNYYY) <br />11 /30/2011 <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 endorsements). <br />PRODUCER Insurance Office of America CONTACT NAME: <br />130 Vantis, Suite 250 PHONE • 94 -297-5962 (ac. No): 949-297-5960 <br />Aliso Viejo, CA 92656 <br />www.ioausa.com CA-License #,OE67768 INWRERA: RLIlnsurange Company,_ <br />INSURED INSURERe: Beazle Insurance Company <br />Johnson-Frank 81 Associates, Inc. <br />5150 E. Hunter Avenue INSURER C: <br />Anaheim CA 92807 INSURER D: <br />INSURER E : <br />NAIC # <br />CAVFRnrFSt CCDTICIr`ATC L11 IRAMOM. <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 />, <br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />INSR <br />LTR <br />TYPE OF INSURANCE ADDL SUB <br />POLICY NUMBER <br />MMIDDY <br /> <br />WDD YY <br />POLICY FXP <br /> <br />LIMITS <br />A GENERAL LIABILITY V ? PSB0001301 12/1/2011 12/1/2012 EACH OCCURRENCE $ 1,000,000 <br /> ? COMMERCIAL GENERAL LIABILITY Scheduled Al Endt <br />#PPB3130610 PREMISES EatN I IzD ce s 1,000,000 <br /> CLAIMS-MADE F7/ OCCUR Professional Services MED EXP (Any one person) S 10,000 <br /> ?_ Priman?On-COntflbUtOr?_ I performed by the insured PERSONAL BADVINJURY $ 1,000,000 <br /> ? Waiver of Subrogation are Excluded GENERAL AGGREGATE 000 <br />$ 2 <br />000 <br /> , <br />, <br /> GEN'L AGGREGATE LIMIT APPLIES PER: <br />P <br />RO PRODUCTS-COMP/OPAGG $ 2,000,000 <br /> ? LOC <br />POLICY ? <br />JECT S <br />A AUT OMOBILE LIABILITY ? ? PSA0001078 12/1/2011 12/1/2012 %=SINGLE LIMIT <br /> <br />Desi <br />nat <br />d I <br />d $ 1,000,000 <br /> V1 ANY AUTO g <br />e <br />nsure BODILY INJURY <br />P <br /> <br />ALL OWNED SCHED <br />Endt #CA20480299 ( <br />er person) <br />$ <br /> AUTOS <br /> <br />E ULED <br />AUTOS <br />NON <br />O <br />WNED Primary/Non-Contributory BODILY INJURY (Per accident) $ <br /> V/ HIREDAUTOS <br />'/ - <br />AAUUTOS and Blanket Waiver of PROP ?R <br />DAMAGE <br /> <br />Subro <br />atio <br />i <br />l <br />d i <br />d ^ $ <br /> ? Primary/Non-Contributory g <br />n <br />nc <br />u <br />n <br />e <br /> Coverage Form #PPA3000311 $ <br /> ? Waiver of Subr ation $ <br />A UMBRELLA LIAB <br /> <br />EXCESS `/ OCCUR <br />PSE0001230 <br />12/1/2011 <br />12/1/2012 <br />EACH OCCURRENCE <br />$4,000,000 <br /> LIAB CLAIMS-MADE Excludes Professional AGGREGATE <br /> <br />Li <br />bilit $ 4,000,000 <br /> DED RETENTION $ a <br />y <br /> $ <br /> $ <br /> i s <br /> WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY Y/ N WC STATU- pTH <br />TORY LIMITS ER <br /> ANY PROPRIETOPJPARTNERJEXECUnVE <br />OFFICERAAEMBER EXCLUDED? <br />NIA <br />E.L. EACH ACCIDENT <br />$ <br /> (Mandatory In NH) <br /> <br />If yes, describe under <br />E.L. DISEASE - EA EMPLOYEE <br />$ <br /> DESCRIPTION OF OPERATIONS helow E.L. DISEASE - POLICY LIMIT $ <br />B Professional Liability <br />Claims-Made V15PR3110401 12/1/2011 12/1/2012 $1,000,000 Per Claim <br /> $2,000,000 Aggregate <br />DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, K more space is required) <br />Certificate Holder is an Additional Insured with respect to General Liability and Automobile Liability but only when required by written contract with <br />the Insured prior to an occurrence as per Endorsement(s) noted above <br />General Liability includes Se <br />ar <br />ti <br />f I <br />d <br />. <br />p <br />a <br />on o <br />nsure <br />s and Contractual Liability <br />per limitations in the BusinessOwners Coverage form. Coverage is subject to all policy terms, conditions, limitations and exclusions <br />30 Day Notice <br />. <br />of Cancellation/10 Day Notice for Non-Payment of premium. <br />CERTIFICATE HOLDER CANCELLATION <br /> <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />CIty of Santa Ana, Its Officers and Employees THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />P. O. Box 1988 ACCORDANCE WITH THE POLICY PROVISIONS. <br />Santa Ana CA 92702 <br /> AUTHORIZED REPRESENTATIVE <br /> AV <br />A <br /> ( <br />C) <br />licia K. I ram <br />v love-cvly /4%.UKU VUKI'UKA 1IUN. All rights reserved. <br />ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD <br />CERT NO.: 11750526 Teresa Frank 11/30/2011 4:28:07 PM Page 1 of 4