FIELDMAN, ROLAPP & ASSOCIATES 5 -2015

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ACCP1f 6r CERTIFICATE OF LIABILITY INSURANCE 111 DATE(MM /DD/YYYY) 1 INSR LTR 5/4/2016 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 June Larson NAME: Millennium Corporate Solutions PHON u (949)679 -6606 A/C No; (949) 679 -6706 License # OC13480 E -MAIL ADDRESS: larson@mcsins.com 5530 Trabuco Road INSURER(S) AFFORDING COVERAGE NAIC # INSURERA:Hanover Insurance 22292 Irvine CA 92620 INSURED INSURERB:Underwriters at Lloyds 15792 Fieldman, Rolapp & Associates, Inc. INSURER C: OH3 A578667 00 19900 MacArthur Blvd. #1100 INSURER D: INSURER E: PERSONAL & ADV INJURY $ 1,000,000 Irvine CA 92612 -2445 INSURER F: COVERAGES CERTIFICATE NUMBER:Renewal Master REVISInN NHMRFP- 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 INSD SUBR WVD POLICY NUMBER POLICY EFF MM /DD /YYYY POLICY EXP MM /DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE X OCCUR EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES Ea occurrence $ 1,000,000 MED EXP (Any one person) $ 10,000 OH3 A578667 00 4/1/2016 4/1/2017 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY F—] JECT D LOC GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP /OPAGG $ 2,000,000 Employee Benefits $ 1,000,000 OTHER: AUTOMOBILE LIABILITY (Ea accident) INEDSINGL -LIMIT $ 1,000,000 BODILY INJURY (Per person) $ A Ix ANY AUTO ALL U TOS OS AUTOS SCHEDULED AU 0113 -711667 00 4/1/2016 4/1/2017 BODILY INJURY (Per accident) $ HIRED AUTOS L NON -OWNED AUTOS PROPERTY DAMAGE Per accident)$ X UMBRELLA LAB OCCUR EACH OCCURRENCE $ 3,000,000 A EXCESS LIAB CLAIMS -MADE AGGREGATE $ DIED I I RETENTION$ $ 1OH3 A578667 00 4/1/2016 4/1/2017 WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR /PARTNER /EXECUTIVE OFFICER /MEMBER EXCLUDED? ❑ NIA PER OTH- STATUTE ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYE $ (Mandatory in NH) If yes, describe under E.L. DISEASE - POLICY LIMIT I $ DESCRIPTION OF OPERATIONS below B Professional Liability SUAWS200491502 12/20/2015 6/19/2017 Aggregate $2,000,000 Retro Date 12/20/2004 Claims Made Policy Retention $250,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) The City of Santa Ana, it's officers, employees, agents and representatives are named as additional insured as per form attached. 30 days notice shall be mailed for policy cancellation. [Replaces certificate dated 3/25/161 REVIEWED BY: A° EUNICE HEREDIA (PG OF ) MBoothe @santa - ana.org City of Santa Ana M36 20 Civic Center Plaza 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 Larson /JUNE (0 1988 -ZU14 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD INS025 /?n14n1`i