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,4c CERTIFICATE OF LIABILITY INSURANCE GATE (MM DOM YYI <br />12 <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 />PRODUCER Insurance Office Of America —_CONTACT NAME=_ rr _ <br />O Vantis, Suite 250 PHONE (AID No E>nr 949-297-5962 <br />- 1F9X1a/C�' <br />Aliso Viejo, CA 92656 - ---- --- <br />E-MAIL ADDRESS' <br />INSURED <br />5150 E. Hunter Avenue <br />Anaheim CA 92807 <br />CA License #OE67768 <br />COVERAGES CERTIFICATE NUMRER-- waoa7na REVISION Mr MBER <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 />INSR TYPE OF INSURANCE POLIDY EFF PpLICY Ex <br />LTR POLICY NUMBER MMIDO/YWY MM/D rY`r`rY LIMITS <br />A <br />GENERAL 11Ae111TY <br />�/ <br />6806825LO07 <br />72/V2D10 <br />12/7 /2011 <br />EACH OCCURRENCE <br />E 1,000,000 <br />COMMERCIALGENERAL LIABILAY <br />Scheduled Al Endt <br />- AMAFNTE 1�- - <br />REMI S Ea oearranre)_ <br />-- --- <br />1,000,000 <br />CLAIMS -MADE OCCUR <br />#CGD3820907 <br />E <br />MED EXP <br />Primary/Non-Contributory - <br />Professional Services <br />performed by the insured <br />10,000 <br />S 1.000.000 <br />PERSONAL BADV INJURY <br />WalVer Of,SUbrOOatlOn _.. _- _ <br />are Excluded <br />- <br />GENERAL AGGREGATE <br />----- - <br />S z000,000 <br />GEN'L AGGREGATE LIMIT APPLIES PER <br />PRODUCTS-COMPpP AGG <br />E 2,000,000 <br />t/ <br />POLICY PRO `/ LOG <br />i <br />E <br />A <br />AUTOMOBILELIABILITY <br />BA68191639 <br />121112CI 11) <br />121 T011 <br />ANY AUTO <br />Designated Insured <br />/ a amnan� <br />E _ 1000000 <br />_ <br />ALL I=. II SCHEDULED <br />Endt #CA2O480299 <br />BODILY INJURY (Pe person) <br />E _-- _--_-,-- <br />_ _ <br />BODILY INJURY (PeracdaenU <br />AUTOS AUTOS <br />Blanket Waiver of <br />y <br />HIRED AUTOS ✓ NO-O <br />NUTOS D <br />I <br />Subrogation #CAT3400808 <br />o9 <br />ve�s rda�DAMn�E <br />-_ ___. <br />E <br />I <br />E <br />A <br />UMBRELLA LIAB ✓ OCaR <br />CUP7915Y817 <br />12/1/2010 <br />72/7/2011 <br />EACH OCCURRENCE <br />s <br />_- <br />gGGREGATE <br />EXCESS LIAB CLAIMS -MADE <br />Excludes Professional <br />_ ,�000.000 <br />S 4,000,000 <br />_✓ DED L._r RETENT10N50 <br />Liability APPROVE,, <br />S 1'O <br />ORM <br />a <br />WORI(ERS COMPENSATION <br />N.0 STATU [��I-I <br />AND EMPLOYERS' LIABILITY y / N <br />ANY PROPRIETOR/PARTNER/EXECUTIVE <br />< <br />^'^`'" Yd t t ee J' <br />- 1%Y LIMITS _ _ ER <br />OFFlOER/MEMBER E%CLVDED'+ NlA <br />(Man,Satory m NN) <br />�,�w- <br />wr,,gsalri [1�p. C)' />: viurn <br />ELEACHACCIDENT S <br />N - ) <br />I(y9a. tleaort»uber <br />; <br />E.L. DISEASE - EA EMPLOYEE S <br />— _ <br />DESCRIPTION OF OPERAT NS Gebw <br />E L. DISEASE - POLICY LIMIT E <br />B Professional Liability <br />V15PR3100301 12/1/2010 <br />12/1/2011 <br />$1,000,00' Per Claim <br />Claims -Made <br />$2,000,000 Aggregate <br />DESCRIPTION OF OPERATIONS / LOCATIONS /VEHICLES (AttecM1 ACORD r pr, 4ddnlonM Remarr,a SCM1eaulq it more space Is r.auaratl) <br />Certificate Holder is an Additional Insured with respect to General Liability and Automobile Liability but only when required by written contract with <br />Named Insured prior to an occurrence as per Endorsament(s) noted above. General Liability includes Separation of Insureds and Contractual <br />Liability per limitations in the Liability Coverage form #C G0'00110(31. Coverage is Subject to al) Policy terms, conditions, Ilmitations and exclusions. <br />30 Day Notice of Cancellation/10 Day Notice for Non -Payment of P—mi— <br />CERTIFICATE HOLDERCANCELLATION_ <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />CitX Of Santa Ana, Its Officers and Employees <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />P.V. BOX 1988 <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />Santa Ana CA 92702 <br />AUTHORIZED REPRESENTATIVE <br />v <br />(AVC Alicia K 1 ram <br />CD leas-2010 ACORD CORPORATION- All rights reserved. <br />ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD <br />CEPT NC] F1996-/Utl T!i¢sa Frank 12 /2/3014 1, L).SU pH Cagc 1 of 5 <br />