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667979 ;Miller Mendel, Inc.
<br />Certificate of Insurance
<br />(page 1 of 1) 01/12/2016 05:22:36 PM
<br />A L,i, CERTIFICATE OF LIABILITY INSURANCE
<br />TE
<br />oA1/12/2016 '
<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(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 />CONTACT
<br />NAME:
<br />PHCNo ,•800-668-7020 nlc Ne: 877)826-9067
<br />00o Techlnsurance
<br />•o• 1301 Central Expy. Scth, Suite 115
<br />• e • Techlnsurance Allen, TX 75013
<br />E-MAIL
<br />ADDRESS:
<br />PRODUCER
<br />CUSTOMER ID #,
<br />INSURERS AFFORDING COVERAGE
<br />NAIC#
<br />INSURED
<br />INSURERA: Beazley Insurance Company Inc.
<br />37540
<br />INSURER B: Sentinel Insurance Company, Limited
<br />11000
<br />Miller Mendel, Inc.
<br />INSURER C :
<br />1425 Broadway Ste 430
<br />Seattle, WA 98122
<br />INSURER D :
<br />CLAIMS -MADE ✓] OCCUR
<br />INSURER E:
<br />0 S �[a''?
<br />'JI
<br />INSURER F:
<br />Iv J
<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 />INSR
<br />LTR
<br />TYPE OF
<br />ADDL
<br />SUBR
<br />POLICY NUMBER
<br />POLICY EFF
<br />MMIDDIYYYY
<br />POLICY EXP
<br />MMIDDNWY
<br />LIMITS
<br />GENERAL LIABILITY
<br />EACH OCCURRENCE $ 1,000,000
<br />✓ COMMERCIAL GENERAL LIABILITY
<br />DA AG ( EN
<br />PREMISESS1,000,000
<br />occurrence $
<br />CLAIMS -MADE ✓] OCCUR
<br />MED EXP (Any one person) $ 10,000
<br />PERSONAL &ADV INJURY $ 1,000,000
<br />B
<br />v/ STOP GAP (see below for limits)
<br />Yes
<br />46SBMUF4112
<br />12/26/2015
<br />12126/2016
<br />GENERAL AGGREGATE $ 2,000,000
<br />GEN'L AGGREGATE
<br />LIMIT APPLIES PER
<br />PRODUCTS.COMP/OP AGO $ 2.000,000
<br />✓ POLICY
<br />PEO LOC
<br />$
<br />AUTOMOBILE
<br />LIABILITY
<br />COMBINED SINGLE LIMIT $ 1,000,000
<br />E. accident)
<br />ANY AUTO
<br />BODILY INJURY (Per person) $
<br />ALLOWNEDAUTOS
<br />BODILY INJURY (Per accident) $
<br />B
<br />✓
<br />SCHEDULED AUTOS
<br />HIRED AUTOS
<br />Yes
<br />46SBMUF4112
<br />12/26/2015
<br />12126/2016
<br />PROPERTY DAMAGE
<br />(Per accident) S
<br />$
<br />✓
<br />NON -OWNED AUTOS
<br />$
<br />UMBRELLA LIAR
<br />OCCUR
<br />EACH OCCURRENCE $
<br />AGGREGATE $
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />DEDUCTIBLE
<br />$
<br />$
<br />RETENTION $
<br />WORKERS COMPENSATION
<br />WC STATU- OTH-
<br />USES ER
<br />B
<br />AND EMPLOYERS' LIABILITYIOSY
<br />ANY PROPRIETORIPARTNER/EXECUTIVE YIN
<br />OFFICERIMEMBER EXCLUDED? r7
<br />(Mandatory in NH)
<br />NIA
<br />46SBMUF4112 (STOPGAP)
<br />12/26/2015
<br />12126/2016
<br />E.L. EACH ACCIDENT $ 1,000,000
<br />E.L. DISEASE - EA EMPLOYEE $ 1,000,000
<br />f mtleran a under STOPGAP
<br />DOF OPERATIONS below
<br />E.L.RIPTION DISEASE - POLICY LIMIT $ 1,000,000
<br />A
<br />Professional Liability (Errors and Omissions)
<br />V177D7150201
<br />12126/2015
<br />12/26/2016
<br />$1,000,0001$1,000,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) -,1 f'
<br />City of Santa Ana is named as Additional Insured as their interests may appear in regards to general liability a utomob' liability. h tl
<br />����"""llllll
<br />4F Z
<br />CERTIFICATE HOLDER
<br />CANCELLATION P '1 u rt -
<br />ACORD 25 (2014/01)
<br />© 1988-2014 ACORD CORPORATION. All rights reserved.
<br />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 />ACORD 25 (2014/01)
<br />© 1988-2014 ACORD CORPORATION. All rights reserved.
<br />The ACORD name and logo are registered marks of ACORD
<br />
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