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CERTIFICATE OF LIABILITY INSURANCE QATE(VimmDlYYYY)
<br />�. 13,,/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 he 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 hen of such endorsement(s).
<br />PRODUCER CONTACT June Larson
<br />9 r�;AAfIE: ..
<br />Millennium, Corporate Solutions PHONE (949) 679 -6606 FAX I�a�a�T� -6r��
<br />LAIC, NQ. EML .._ (AIC,,NoC _
<br />License # OC13480 EMAIL l
<br />ADDRESS: arson @mcsins.com
<br />5530 Trabuco Road INSURER(S) AFFORDING COVERAGE NAIL #
<br />Irvine CA 92620 )NSVRER✓Banover Insurance 22292
<br />INSURED INSURER 0 „Underwrite s at Lloyds 157,92„ .
<br />Fieldman, Rol,app & Associates, Inc. INSURERS:
<br />19900 MacArthur Blvd, Suite 1100 KY @'mnrn_
<br />Irvine CA 92612 1 INSURER F': j
<br />`0VFP=P9 CFRTIFIr ATF RI'I IIUIRFP- CL1_5112411171 r r_%1I .2InlU KII IIUIL]ccti•
<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
<br />CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY
<br />THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMIT'S SHOWN MAY HAVE BEEN
<br />REDUCED BY PAID CLAIMS,
<br />iNSR TYPE OF INSURANCE A66LIS B-A`
<br />LT POLICY NUMBER
<br />POLICY EFF_ POLICY EkP
<br />MMPOOIYYYY MMIDD6YYYY LIMITS
<br />IaA.7CC.LtlR
<br />3C COMMLAIMS-
<br />EAgH,PgCURRENCE 1,OQ0,00O
<br />MADEERX
<br />-' .I q
<br />DAMAGE
<br />DAMAGE TO RENTED
<br />MISES” Ee gccurmncaa ... 1,000,000
<br />, r Ol3 A578667 00 I
<br />. ....
<br />YS 10,000 004 / 1/2019 4/1/2016
<br />I j
<br />PERSONALSADV INJURY 1,000,000
<br />,.. ,. ..
<br />GENT AGGREGATE LIMIT APPLIES PER
<br />.,
<br />GENERAL AGGREGATE GRATE 5 2,000,000
<br />r,E
<br />_.,
<br />., . .
<br />POLICY ......I JE Q L7C i
<br />r PRODUCTS - COMP/OP AGO ' S 2,000,000
<br />. _
<br />i OTHER:
<br />Employee BeneEls - S 1,000,000
<br />AUTOMOBILE LIABILITY -
<br />COMBINED SINGLE LILIIT
<br />(Ea accident)
<br />i ANY AUTO
<br />A
<br />BODILY IN JURY IPer person) $
<br />ALL OWNED ":SCHEL7LPk.ED OHS A57860 00
<br />:AI1'8'OS AUTOS ,
<br />4/l/2015 4/l/2016 BODILY INJURY(Peraccutentl S
<br />,
<br />FlIh7ECI ACJT't1li
<br />PROPERIYfYA" _..._
<br />DAMAGE S
<br />AI,yTOS j k !.
<br />j AUTOS
<br />(Per acc¢denll . _ ... _
<br />X No Owned Autos
<br />X UMBRELLA, LiAB
<br />y OCCUR
<br />EAGH,4'�CCIJRRENCE S ... 3,,000,000
<br />EXCESS ILIAD CLAIMS -MADE
<br />A
<br />j AC.G,REGATE $
<br />DED ''..RETPNTI0N$ 'OH3 A578667 00 '...�
<br />4/1/2015 4/1/2016 ';,, 5
<br />WVORKERS COMPENSATION
<br />-
<br />7R
<br />AND EMPLOYERS' LIABILITY YIN
<br />A T TE 2 R .H....
<br />.._.. ...... ..
<br />ANY PROPRIETOR PARTNERUEXEGJTIVE,',
<br />E L. EACH ACCIDENT S
<br />OF�FICE'�RWEMSER EXCLUDED? N I A
<br />.....
<br />(Mandatory In NH)
<br />�',,. E.L. DiISEAS"E. - EA EMPLOYEE S
<br />If yes, descfte tinder
<br />DE,EoCMPTION OF OPERAT'TONS bray,, .
<br />E.N._ DISEASE - I "DI- 6G,;"A LlhdtlT
<br />B Errors & omissions SUA11849CYB1502 .,
<br />i
<br />12/20/20151, 6/19/2017 Aggregate $2,000.,000
<br />:Petro date 12/20/2004 Claims Made Policy
<br />Rer nhun $250,000
<br />DESCRIPTION OF OPERATIONS t LOCATIONS I VEHICLES (ACORD ipi., Adltlilional Rentark:s Schedule, may be attached if more space i6 required)
<br />The City of Santa Area, it's officers, employees, agents and representatives are named as additional
<br />insured as per :corm attached.
<br />30 days notice shall be mailed for policy cancellation„
<br />°
<br />/
<br />ili.Wi IdV 4 k
<br />: 114,C E KEICI D A (PG OF
<br />City of Santa Ana
<br />Finance & Management Services Agency
<br />20 Civic Center Plaza
<br />Santa Anna, CA 92701
<br />LOJ_10L "qR 11 71 Eel 01
<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 />J1tYir; Lr¢I n?tl ,,7 @)II',,
<br />q) 3988 -2014 ACORD CORPORATION. All rights reserved
<br />ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD
<br />INSn25r,mi4mi
<br />
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