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MACIGIN -01
<br />® CERTIFICATE OF LIABILITY INSURANCE DATE 4126 /DD/YYYY)
<br />4/26/2012
<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 endorsement(s).
<br />PRODUCER CONTACT Tracy Dolan
<br />NAME: _ y
<br />Wells Fargo Insurance Services USA, Inc. PHONE 916 231 -1757 FAx 916 231 -1868
<br />j_ A/ C,. No,- �;----------- ._._.------- .__ - - -- -- A/C Nod
<br />CA DOI Lic. #OD08408 (916) 231 -1741 E-MAIL @
<br />ADDRESS: .dolan trac y wellsfar g o.com
<br />11017 Cobblerock Drive, Suite 100 INSUREKSJAFFORDING COVERAGE NAIC #
<br />Rancho Cordova, CA 95670 -6049 INSURER A: National Surety Corporation 21881
<br />INSURED INSURER B: Oak River Insurance Company 34630
<br />Macias Gini & O'Connell LLP
<br />Macias Consulting Group & INSURER _D :
<br />Intellibridge Partners LLC
<br />INSURER E:
<br />3000 S St. Ste 300, Sacramento, CA 95816 A- 40
<br />INSURER F:
<br />COVERAGES CERTIFICATE NUMBER: 4244856 REVISION NUMBER:' Saw hwlnw
<br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR'THE 0.9LICY 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 A6L THE TERMS,
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ==
<br />-- ----- ----- --- --- - - - - - -- POLICY ---
<br />INSR ADDL SUBR POLICY EFF PODCY EXP MI TS '-
<br />LTR TYPE OF INSURANCE POLICY NUMBER MM/DD/YYYY MM /DD/YYYY U'
<br />A
<br />GENERAL LIABILITY
<br />--
<br />X COMMERCIAL GENERAL LIABILITY
<br />AZC80863843
<br />04/30/2012
<br />04/30/2013
<br />EACH E T RRENC,I - :;1 _
<br />PREMISES [ RENTED- `'
<br />PREMISES jEa occurrent "e� _ _ _
<br />$ 2,000,000
<br />L/1 1,000,000
<br />$ _- _
<br />CLAIMS -MADE Fx OCCUR
<br />MED EXP (Any one person)
<br />$ 10,000
<br />-
<br />PERSONAL & ADV INJURY
<br />$ 2,000,000
<br />$ 4,000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />GENERAL AGGREGATE
<br />PRODUCTS - COMP /OP AGG
<br />$ 4,000,000
<br />X POLICY PRO LOC
<br />JECI
<br />$
<br />A
<br />AUTOMOBILE
<br />LIABILITY
<br />AZC8086:3843
<br />04/30!2012
<br />04/30/2013
<br />COMBINED SINGLE LIMIT
<br />2,000,000
<br />BODILY INJURY (Per person)
<br />$
<br />ANY AUTO
<br />_
<br />-
<br />ALL OWNED SCHEDULED
<br />AUTOS — AUTOS
<br />BODILY INJURY (Per accident)
<br />$
<br />X
<br />$
<br />NON -OWNED
<br />HIRED AUTOS X AUTOS
<br />PROPERTY DAMAGE
<br />Per ccident
<br />x
<br />$
<br />No Owned Au
<br />A
<br />UMBRELLA LIAB
<br />X EXCESS LIAB
<br />X
<br />17
<br />OCCUR
<br />CLAIMS -MADE
<br />AZC80863843
<br />04/30/2012
<br />04/30/2013
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />$ 1,000,000
<br />--------- ---
<br />AGGREGATE
<br />DED x RETENTION $ 0
<br />$ 2,000,000
<br />B
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY Y / N
<br />ANY PROPRIETOR /PARTNER/EXECUTIVE
<br />OFFICER /MEMBER EXCLUDED?
<br />N/A
<br />3300055235 -12
<br />04/30/2012
<br />04/30/2013
<br />X I WC STATU- OTH-
<br />- - -- 413Y lJM1TS _ -- -Ef3-
<br />_ -_ __- -.
<br />1,000,000
<br />$
<br />E.L. EACH ACCIDENT
<br />$ 1,000,000
<br />(Mandatory in NH)
<br />E.L. DISEASE - EA EMPLOYE
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />__-
<br />E.L. DISEASE - POLICY LIMIT
<br />$ 1,000,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required)
<br />RE:Audit work perfomed on behalf of the certificate holder - Certificate holder is named additional insured per the attached AB 9189 08/07 form.
<br />-r_r% r IrwA I c nvLurR IV I c GANGtLLA 1 IUN
<br />Santa Ana Empowerment Zone Corporation
<br />20 Civic Center Plaza M -21
<br />P.O. 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 REPRESENTATIVE
<br />004287 The ACORD name and logo are registered marks of ACORD © 1988 -2010 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2010105)
<br />11111111111111111111111111111111111 IIII Illli IIII) 11111 VIII VIII VIII VIII VIII VIII IIII IIII 'CY80116/0014521()M 0/010/0'
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