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.4U"RL7 CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDOryYYY) <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF���N ONLY AMP 041FERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS <br />CERTIFICATE DOES NOT AFFIRMATIVELY OR N, dATIVELY AMENp. 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 pollcy(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 endorsements . <br />PRODUCER Insurance Office of America oNTACT NAME• VC} Betty Tian <br />130 Vantis, Suite 250 PHONE (A& Hg Extl: , 680-f78D _ I FAx (A�e. Nm: q4g ps7-sss <br />Aliso Viejo, CA 92656 <br />E-MAIL ADDRESS: batty.tranCa%108USfl•COm _ . <br />INSURER AFFORDING COVERAGE NAIL s <br />w .ioausa.com CA License #OE67768 INSURER A:--Sto CompensationJna ffm&Fmn�L— - 35076_ .. <br />INSURED INSURER B: <br />Johnson -Frank & Associates, Inc. <br />5150 E. Hunter Avenue INSURER C <br />Anaheim CA 92807 INSU REA D: <br />INSURER E <br />I INSURER F : <br />CAVFAAnFS rCGTlclr`ATC Kill Ilamco. <br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAAVE 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 AFFORpED 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 - - D <br />L TYPE OFINSURANCE <br />UBR -- POLICY EFF POLIOyy EXP <br />POLICY NUMBER M D^IYY LIMITS <br />GENERAL LIABILITY <br />OCCURRENCE <br />S <br />COMMERCIAL GENERAL LIABILITY <br />pEAAryC1HH <br />PREMISES Ea RENTED <br />occurrence) <br />$ <br />J CLAIMS -MADE LOCCUR <br />MED EXP "one person) _ <br />q <br />PERSONAL & ADV INJURY <br />$ _ <br />.. _ <br />GENERAL AGGREGATE <br />$ <br />GEN'L AGGREGATE LIMIT APPLIES PER <br />POLICY . PRO LOC <br />PRODUCTS <br />� <br />S <br />-$ <br />AUTOMOBILE <br />UABIUTV <br />Ea eCBINEenDi15 IMIT <br />$ <br />BODILY INJURY (Per person) <br />BODILY WURY(Per accident) <br />. <br />ANY AUTO <br />ALL OWNED !�j SCHEDULED <br />AUTOS LUJ AUTOS <br />NON -OWNED <br />HIRED AUTOS AUTOS <br />����0V LJ 0 <br />tl Lil✓ <br />.✓"• - <br />, <br />`�0 <br />T� <br />RM <br />S <br />S <br />S <br />PROPERTY AMAGE <br />Per acadentF <br />- <br />EACH OCCURRENCE <br />S <br />UMBRELLA LIAB OCCUR <br />Laura Stit <br />sheedy <br />EXCESS LIAR CLAIMS -MACE <br />t� <br />A,SS1StaAt City <br />A.ttorn <br />Y <br />_ <br />$ <br />AGGREGATE <br />RETENTION 5 <br />- <br />$ <br />$ <br />$ <br />A <br />WORKERSCOMPENSATION <br />AND EMPLOYERS• LIABILITY Y r N <br />ANY PROPRIETOFdPARTNERIEXECUTIVE <br />OFFICERIMEMBER EXCLUDED? a'NIA <br />(t yes, d ory In andNH) <br />If yes, describe under <br />1 <br />of Su <br />Waiver <br />Waiver of Subrogation <br />Endt #10217 <br />1 Ji/2013 <br />111 /2014 <br />WCSTATU- OT,ti- <br />1/ T Y MRS. <br />! $ 1,QDO OOO <br />E.L. EACH ACCIDENT <br />- <br />E.L. DISEASE - EA EMPLOYEE <br />- <br />; _ �_Q�_00 <br />E.L. DISEASE - POLICY LIMIT <br />DESCRIPTION OF OPERAT NS below <br />$ 1 ,000,00TT <br />L_ <br />L <br />DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks; Schedule, It more space Is required) <br />A Workers' Compensation Waiver as noted above is included for all persons or organizations named in the Schedule that are parlICS to a contract that <br />require this Endorsement, provided that contract is executed before the loss. Coverage is subject to all policy terms, cond-lions, limitations and <br />exclusions. 30 Day Notice of Cancellation. <br />GERTIFICAIg HOLDER <br />CANCELLATION <br />Cftx of Santa Ana, its officers and employees <br />SHOULD ANY OFTHE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />P.U. BOX 1988 <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />Santa Ana CA 92702 <br />AUTHORIZED REPRESENTATIVE <br />AVC Alicia K. I ram <br />©1998-2010 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2010/05) The ACORD name and logo aide registered marks of ACORD <br />C3RT NO.: 15246328 (AVCI Belay Tran 1/1512013 11:01:54 AM PagA 1 of 1 <br />