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ACOR® CERTIFICATE OF LIABILITY INSURANCE �-- DATE(MM/DD/YYYY) 6/29/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Andrea Martin Millennium Corporate Solutions License # OC13480 PHONE Extl. (949) 857-4500 FAX No): (949)857-9800 E-MAIL ADDRESS: amartin@mcsins.com 5530 Trabuco Road Irvine CA 92620 INSURER(S) AFFORDING COVERAGE NAIC # INSURERA:Citizens Insurance Company of INSURED INSURER B : Acire, Inc INSURERC: 211 Simplicity INSURERD: -- ------- -- INSURER E : i--- Irvine CA 92620-2828 INSURERF: COVERAGES CERTIFICATE NUMBER:CL1662933492 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL I D SUBR : WV POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP- MM/DD/YYYY LIMITS A X ',. COMMERCIAL GENERAL LIABILITY I �OCCUR CLAIMS -MADE I X ( EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES (Ea occurrence) $ 30,000 MED EXP (Any one person) $ 5, 000 OB3 A034591 03 7/6/2016 7/6/2017 - PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEML AGGREGATE LIMIT APPLIES PER: X POLICY PEC (—� LOC _ PRODUCTS - COMP/OP AGG $ 2,000,000 Hired & Non -Owned Auto $ 1,000,000 ''.. OTHER: AUTOMOBILE LIABILITY Ea cccidentSINGLE LIMIT $ 1,000,000 BODILY INJURY (Per person) $ A ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS OB3 A034591 03 7/6/2016 7/6/2017 - BODILY INJURY (Per accident) -- - $ NON -OWNED % HIRED AUTOS R AUTOS _ � I PROPERTY DAMAGE . (Per accident - - $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ '.... EXCESS LIAB CLAIMS -MADE -------- AGGREGATE _ $ DED RETENTION $ ---------- ----------------- $ f WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? N / A l ( PER OTH- _ STATUTE OR E.L. EACHACCIDENT -ACCIDENT $- ------ E.L. DISEASE - EA EMPLOYE ----------- $ (Mandatory in NH)— If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT _ $ A I PROFESSIONAL LIABILITY I i OB3 A034591 03 7/6/2016 7/6/2017 EACH CLAIM $1,000,000 CLAIMS -MADE ! i AGGREGATE $2,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) The City of Santa Ana is included as additional insured with primary & non-contributory wording for general liability per attached form 391-1006 0609 when required by written contract as respects to the insureds operations. p *10 days notice of cancellation for non-payment of premium. / R EWE IRE Er Ni a / E:I &m la G H) N E INN quo, Jo y j —1— ,vr - 1--1 ____... %,MIVLGLLH I IVIY City of Santa Ana 20 Civic Center Plaza, M-36 Santa Ana, CA 92701 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Diem Jurkosky/DIEM -✓2 - ACORD 25 (2014101) INS025 /9ni4nn (J'I VIRS-[U'l4 A(:URU CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD