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667979 Miller Mendel, Inc. Certificate of Insurance (page 1 of 1) 12/31/2015 02:15:57 AM <br />CERTIFICATE OF LIABILITY INSURANCE <br />DA12//31/231/201155 T ) <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. Ot 4-k";'! „ ; irL T i 2 <br />IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(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 endorsement(s). <br />PRODUCER <br />NAMECT Iiat 1tL -` <br />000 Techlnsurance <br />•o• 1301 Central Expy. South, Suite 115 <br />• 01 Tech Insurance Allen, TX 75013 <br />jprcNNo E:o. 800-559-7020 FAX 826-9067 <br />EMAIL <br />ADDRESS: <br />PRODUCER <br />GENERAL LIABILITY <br />CUSTOMER ID N: <br />INSURERS AFFORDING COVERAGE NAICN <br />INSURED <br />INSURER A: Beazley Insurance Company Inc. 37540 <br />INSURER B: Sentinel Insurance Company, Limited 11000 <br />Miller Mendel, Inc. <br />INSURER C <br />1425 Broadway Ste 430 <br />Seattle, WA 98122 <br />INSURER D <br />INSURER E, <br />INSURER F: <br />MED EXP (Any one person) $ 10,000 <br />COVERAGES CERTIFICATE NUMBER: 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 />/NSR <br />R <br />TYPE OFINSURANCE <br />ADOL <br />UBR <br />POLICY NUMBER <br />MMIDOM'YLICY Y <br />MWIDDM/YV <br />LIMITS <br />GENERAL LIABILITY <br />EACH OCCURRENCE $ 1,000,000 <br />COMMERCIAL GENERAL LIABILITY <br />Y'PREMISESS <br />DAMAGE1,000,000 <br />EEd <br />Ed occurrence $ <br />occurrence) <br />MED EXP (Any one person) $ 10,000 <br />CLAIMS -MADE ✓OCCUR <br />PERSONAL &ADV INJURY $ 1,000,000 <br />B <br />✓ STOPGAP(... below far limits) <br />Yes <br />46SBMUF4112 <br />12/28/2015 <br />12/26/2016 <br />GENERAL AGGREGATE S 2,000,000 <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />PRODUCTS - COMP/OP AGO if 2,000,000 <br />RO LOC <br />17 POLICY PECT <br />$ <br />AUTOMOBILE <br />LIABILITY <br />COMBINED SINGLE LIMIT $ 1,000,000 <br />(Ea accident) <br />ANY AUTO <br />BODILY INJURY (Per person) $ <br />ALL OWNED AUTOS <br />BODILY INJURY (Per accident) S <br />B <br />✓ <br />SCHEDULED AUTOS <br />HIRED AUTOS <br />Yes <br />468BMUF4112 <br />12/26/2015 <br />1212612016 <br />PROPERTY DAMAGE <br />(Peraccldenl) S <br />✓ <br />NON-ONMEO AUTOS <br />S <br />S <br />UMBRELLA LIAB <br />OCCUR <br />EACH OCCURRENCE S <br />AGGREGATE 5 <br />EXCESS LIAB <br />CLAIMS -MADE <br />DEDUCTIBLE <br />$ <br />$ <br />RETENTION $ <br />WORKERS COMPENSATIONWC <br />STATU- OTH- <br />AND EMPLOYERS'LIABILITY YIN <br />T T <br />E.L. EACH ACCIDENT g 1,000,000 <br />B <br />ANY PROPRIETOR/PARTNER/EXECUTIVE <br />OFFICER/MEMBER EXCLUDED? ❑ <br />NIA <br />46SBMUF4112 (STOPGAP) <br />12/26/2015 <br />12/26/2018 <br />EL.DISEASE-EAEMPLOYE $ 1,000,000 <br />(Mandatory in NH) <br />Uses describeunder STOPGAP <br />DESCRIPTION OF OPERATIONS below <br />E. L. DISEASE - POLICY LIMIT $ 1,000,000 <br />A <br />Professional ITabllity(Errors and Omissions) <br />V177D7140101 <br />12/26/2015 <br />12/26/2016 <br />$1,000,000/$1,000,000 <br />DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is required) <br />City of Santa Ana is named as Additional Insured as their interests may appear in regards to general liability and automal,11111 <br />r <br />x <br />CERTIFICATE HOLDER CANCELLATION / / l <br />©1988-2014 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />City of Santa Ana <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />20 Civic Center Plaza <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />Santa Ana, CA 92701 <br />AUTHORIZED REPRESENTATIVE <br />©1988-2014 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD <br />