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A-2011-005
<br />AC DATE (MMIDD[Y'YYY)
<br />�o CERTIFICATEOF LIABILITY INSURANCE
<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 IN'SURER(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 dues not confer rights to the
<br />certificate holder in lieu of such endorsement(s).
<br />PRODUCER IIt7A Insurance Services CONTACT
<br />Ni Betty Trap
<br />130 Vantis, Suite 250 PHONE FAX
<br />Aliso Viejo, 9265 a (AX, No, Ext): 9,49-297-5962 (AIC, No). 949-297-5960
<br />wwwJoausa com CA License #OE67768
<br />INSURED
<br />Johnson -Frank & Associates, Inc.
<br />5150 E. Hunter Avenue
<br />Anaheim CA 92807
<br />INSURER D :
<br />INSURERIS) AFFORDING COVERAGE NAIC p'
<br />RLI Insurance Company 13056
<br />COVERAGES CERTIFICATE NUMBER! 99AQ719n RFVLI;IC)N NIIMRi
<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
<br />TERMS,
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />INSR SUBA
<br />LTR '....... TYPE OF INSURANCE IN$D WVD POLICY NUMBER I lt-"4©Y/YXYY MMPDDWYYY ... LIMITS
<br />A f' COMMERCIAL GENERAL LIABILITY ,Y/ IPSB0001301 ',.... 12/1/2014 12/1/2015 EACH OCCURRENCE '',. $
<br />1.,.000,000..
<br />CLAIMS-MRDIE ,✓ '.., OCCUR Scheduled Al Endt DAMAGE TO R'RNTED .._
<br />PREMISES (Ed occurrence) $
<br />_.. ...
<br />1,000,000
<br />#PPB3130212
<br />/ Prim/NonCon MED EXP (Any one person) $
<br />Professional Services
<br />10,000
<br />/ Wvr of Subr performed by the Insured PERSONAL a RDV INJURY $
<br />.....
<br />1.000,000
<br />GEN'L AGGREGATE UMIIT APPLIES PE'..R„ are Excluded '....... GENERAL AGGREGATE $
<br />. ,._r✓
<br />2,000,000
<br />PRO-
<br />POLICY JECT ✓ '... LOC '.. ''.. PRODUCTS - COMi AGG $ _
<br />._... ...... ........
<br />2,000,000
<br />OTHER: $
<br />A AUTOMOBILE LIABILITY PSA0001078 112/1/2014 12/1/2015 (a accident) SINGLE LIMIT $
<br />1,000 000
<br />'
<br />,✓ '...... ANY AUTO Designated Insured Endt BODILY INJURY (Per person) $ _
<br />ALL OWNED ... SCHEDULED '....-#CA20481013;. Prim/NonCon '... BODILY INJURY (Per accident) $
<br />........
<br />AUTOS and Blkt Wvr of Subr
<br />NON -OWNED
<br />NON -OWNED PROPERTY DAMAGE V i. HIRED AUTOS ✓... AUTOS '..,included on pg 2 of Form (Per accident)_ $
<br />_
<br />.
<br />/ Prim/NonCon Wvr of Subr #PPA3000313 $
<br />A UMBRELLA LIAR OCCUR PSE0001230 12/1/2014 121112015 EACH OCCURRENCE $
<br />4,000,000
<br />f '.. EXCESS HAS CLAWIS-MADE Excludes Professional AGGREGATE .._ _...... S
<br />4,000,000
<br />Liability
<br />_DED
<br />RETENTION 5 '. $
<br />A WORKERS COMPENSATION PSWO002298 12/1/2014 12/112015 ORTH-
<br />,STATUTE .... .._
<br />AND EMPLOYERS' LIABILITY Y t N Waiver of Subrogation
<br />ANY PROPRIETO€JPARTNERFEXECUTIVE E.L. EACH ACCIDENT $
<br />OFFICERIMEMBER EXCLUDED? ® NIA Endt #WC0403060484
<br />1,000,000
<br />(Mandatory in NH) ''., E.L. MSEASE -EA EMPLOYEE. $
<br />1,000,000
<br />li yes, de5CF11 a under
<br />DESCRIPTION OF OPERATIONS bebnw✓ ''. ' '.. E.L. DISEASE - POLICY LIMIT $
<br />1,000,000
<br />A Professional Liability RDPOO17745 12/l/2014 12/1/2015 $2,000,000 Per Claim
<br />Claims -Made $2,000,000 Aggregate
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may he attached if more space is required)
<br />Certificate Holder is an Additional Insured with respect to General Liability (GL) and Automobile Liability but only when required by written contract
<br />with the Insured prior to an occurrence as per Endorsements noted above. GL includes Separation of Insureds and Contractual Liability per limitations
<br />in the BusinessOwners" Coverage form. A Workers' Compensation Waiver of Subrogation as noted above is Included for the person or organization named
<br />in the Schedule that are parties to a contract requiring this Endorsement, provided that contract is executed' before the toss, Coverage subject to all
<br />policy terms, conditions, lumitations and exclusions. 30 Day Notice of Cancel/10 Days for Non -Payment in accordance with policy provisions.
<br />JOHNSON-FRANK & ASSOCIA, ES, I. C: AGREEMENT A-2011-098
<br />REVIEWED BY:� ~'��� EUNICE HEREDIA PG. 1 of 5
<br />CERTIFICATE HOLDER CANCELLATION
<br />Cityy of Santa Ana, its officers and employees
<br />IDI Box 1988
<br />Santa Ana CA 92702
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />AUTHORIZED REPRESENTATIVEY
<br />(AVC) Alicia. K. Igram
<br />@ 1988-2014 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD
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