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A00R°® CERTIFICATE OF LIABILITY INSURANCE <br />�' <br />­DATE 11 /24 /201 Y) <br />11/24/2015 <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 <br />CONTACT JUr10 Larson <br />NAME: <br />Millennium Corporate Solutions <br />License # OC13480 <br />PHONE ExO� (949)679 -6606 NC No: (949)679 -6706 <br />ADDRESS, 3 E -MAIL Larson @mcsins. com <br />5530 Trabuco Road <br />INSURERS AFFORDING COVERAGE <br />NAIC# <br />INSURER A:Hanover Insurance <br />22292 <br />Irvine CA 92620 <br />INSURED <br />INSURER B.Underwriters at Lloyds <br />15792 <br />INSURERC: <br />CLAIMS -MADE ❑X OCCUR <br />Fieldman, Rolapp & Associates, Inc. <br />INSURER D: <br />19900 MacArthur Blvd. Suite 1100 <br />INSURER E: _ <br />PREMISES O(Ea.mourni <br />$ 1,000,000 <br />INSURER F: <br />MED EXP(Any one person) <br />Irvine CA 92612 <br />COVERAGES CERTIFICATE NUMBER:CL15112431173 REVISION NUMBER: <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 />ILTR <br />TYPE OF INSURANCE <br />IN SD <br />VD <br />POLICY NUMBER <br />PMIDDDIYYYVY <br />MMIDOIYY %VY <br />LIMITS <br />AUTHORIZED REPRESENTATIVE <br />X <br />COMMERCIAL GENERAL LIABILITY <br />June Larson /JUNE <br />EACH OCCURRENCE <br />$ 1,000,000 <br />A <br />CLAIMS -MADE ❑X OCCUR <br />PREMISES O(Ea.mourni <br />$ 1,000,000 <br />MED EXP(Any one person) <br />$ 10,000 <br />OH3 1,578667 00 <br />4/1/2015 <br />4/1/2016 <br />PERSONAL &ADV INJURY <br />$ 1,000,000 <br />AGGREGATE LIMIT APPLIES PER', <br />POLICY �jECT LJ LOC <br />GENERAL AGGREGATE <br />$ 2,000,000 <br />GEN'L <br />X _ <br />PRODUCTS- COMPIOPAGG <br />$ 2,000,000 <br />Employee Benefits <br />$ 1,000,000 <br />OTHER: <br />AUTOMOBILE <br />LIABILITY <br />COMBINED SINGLE L MIT <br />(Es nccMant <br />$ 1,000,000 <br />BODILY INJURY <br />$ <br />A <br />ANY AUTO <br />ALLOWNED SCHEDULED <br />SCHEDULED <br />AUTOS AUTOS <br />OH3 A578667 00 <br />4/1/2015 <br />4/1/2016 <br />BODILY INJURY(Peraccident) <br />$ <br />Perr accident AMAGE <br />$ <br />X <br />HIRED AUTOS X AUTOS WNED <br />✓ <br />$ <br />X No Owned Autos <br />X <br />UMBRELLA LIAB <br />OCCUR <br />EACH OCCURRENCE <br />$ 3,000'.000. <br />AGGREGATE <br />$ <br />A <br />E %CESS LIAB <br />CLAIMS -MADE <br />DE O RETENTION$ <br />$ <br />OH3 1,578667 00 <br />4/1/2015 <br />4/1/2016 <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY YIN <br />X <br />I I PER OTH- <br />STATUTE ER <br />E.L. EACH ACCIDENT <br />$ <br />ANY PROPRIETORIPARTNERIEXECUTIVE <br />OFFICER/MEMBER EXCLUDED? <br />NIA <br />E,L, DIBEASE -EA EMPLOYE <br />$ <br />(Mandatory in NH) <br />If yes, describe under <br />- - - <br />DESCRIPTION OF OPERATIONS below <br />EL DIBEASE - POLICY LIMIT <br />$ <br />B <br />Errors & Omissions <br />SUA11811CYB1502 <br />12/20/2015 <br />6/19/2017 <br />Aggregate $2,000,000 <br />Retro date 12/20/2004 <br />Claims Made Policy <br />Retention" $250,000 <br />v/ <br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) <br />The City of Santa Ana, it's officers, employees, agents and representatives are named as additional <br />insured as per form attached. <br />30 days notice shall be mailed for policy cancellation. <br />CERTIFICATE HOLDER CANCELLATION <br />ACORD 25 (2014101) <br />INS02512014011 <br />©1988 -2014 ACORD CORPORATION. All rights reserved. <br />The ACORD name and logo are registered marks of ACORD <br />v/ <br />V/ <br />I/ <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />/City <br />of Santa Ana <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />Finance & Management Services Agency <br />20 Civic Center Plaza <br />AUTHORIZED REPRESENTATIVE <br />Santa. Ana, CA 92701 <br />June Larson /JUNE <br />ACORD 25 (2014101) <br />INS02512014011 <br />©1988 -2014 ACORD CORPORATION. All rights reserved. <br />The ACORD name and logo are registered marks of ACORD <br />v/ <br />V/ <br />I/ <br />