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A : a CERTIFICATE ®F LIABILITY INSURANCE
<br />3/12/20 5""'
<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($), AUTHORIZED
<br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
<br />IMPORTANT: It the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIV80, subject to
<br />the terms and conditions of the policy, certain pollcies may require an endorsement, A statement on this certificate does not confer rights to the
<br />certificate holder In lieu of such endorsement(s).
<br />PRODUCER
<br />Millennium Corporate Solutions
<br />License # OC134BO
<br />5530 Trabuco Road
<br />Irvine CA, 52620
<br />CONTA T Jurie 7rar30n
<br />ONE (949) 679_6606 FAK 199 41 679 -6 607 Noli
<br />E-MAIL
<br />ODRIESS!
<br />INSURERS AFFORDING COVERAGE
<br />NAIC N
<br />INSURERA;HanQVer Insurance AXV
<br />222.92
<br />INSURED F"ieldman, Rolapp & Associates, Inc.
<br />Fieldman, Rolapp F,inan,cial, Services, LLC
<br />Applied Beat Practices, LLC
<br />19900 MacArthur Blvd, Suite 1100
<br />Irvine CA 92612
<br />INSURERBrLIC ds of London (A-FXV)
<br />85202
<br />INSURERC -.
<br />INSURER D;
<br />INSURERS:
<br />$ 1,000,000
<br />INSURER F
<br />X COMMERCIAL GENERAL LIABILITY
<br />=1 CLAIMS -MADE a] OCCUR
<br />COVERAGES CERTIFICATE NLIMRER,15°-16 AI REVI310N NIJMRFR-
<br />THIS IS TO CERTIFY T14AT 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 FOLICIE6, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />INSR
<br />-LrL
<br />TYPE OF INSURANCE
<br />DD
<br />SUER
<br />POLICY NUMBER
<br />M MLIC L'FF
<br />POLICY EXP
<br />LIMITS
<br />05NERALLIABILITY
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />A
<br />X COMMERCIAL GENERAL LIABILITY
<br />=1 CLAIMS -MADE a] OCCUR
<br />DH3 A579667 00
<br />4/1/2015
<br />/1/201.6
<br />PREM E '
<br />PREMISES E .r
<br />000 000
<br />$ r ,
<br />MED EXP (Any one perwrj)
<br />$ 10,000
<br />PERSONAL &ACV INJURY
<br />$ 1,000,000
<br />.�^
<br />GENERAL AGGREGATE
<br />$ 2,000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />PRDiIUCTS - COMPIOP AGG
<br />$ 2,000,000
<br />X POLICY PRO L00
<br />IMT
<br />$
<br />AUTOMOBILE
<br />LIABILITY
<br />Ee aBcldeDfSINGLE Li
<br />1,000,000
<br />BODILY INJURY [f er peraun)
<br />$
<br />A
<br />ANY AUTO
<br />ALLY NED SCHEDULED
<br />AUTOS
<br />X NON-OWNED
<br />HIRED AUTOS AUTOS
<br />H3 A578667 00
<br />4/1/207.5
<br />4/1/2016
<br />BODILY INJURY (Par accldont)
<br />$
<br />P 0 o DAMAGE
<br />f l " L
<br />$
<br />$
<br />X
<br />UMBRELLALIAB
<br />X
<br />OCCUR
<br />EACHOCCUPRRENCC
<br />3,000,000
<br />AGGREGATE.
<br />$�
<br />A
<br />EXCESS LIAR
<br />CLAIMS-MACE
<br />nED .Fr
<br />1
<br />$
<br />lOa3 ,A.578667 00
<br />4/4/2015
<br />4/1/2015
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY y f N
<br />ANY PROPRIETORIPARTNER/EXECUTIVE❑
<br />OFFICERIMEMBER EXCLUDED?
<br />NIA
<br />WC S PATU aThl-
<br />M
<br />E,L.EACHACCIDENT
<br />$
<br />E,L, DISEASE - EA EMPLOYE
<br />$
<br />(Mandatory in NH)
<br />If yes, descrlhe under
<br />DESCRIPTION OF OPERATIONS below
<br />E.L DiSEASE - POLICY LIMIT
<br />$
<br />B
<br />xrrors & Omission
<br />uAW92C0491407.
<br />12/20/201412120
<br />/2015
<br />Aggregate $2,000,OOC
<br />Retro date 12/20/2004
<br />laimE Made Policy
<br />Retention $250,000
<br />DESCRIPTION OF OPERATIONS 1 LDCA71ONS /VEHICLES /Attach ACORD 104, Addltlennl Remarks Schedule, If mDre SpaeD ID rQ401radi
<br />The City of Santa Ana, it's offiaors, employees, agents and representatives are named as additional.
<br />;Lnourod as per form attached,
<br />30 days notice shall be mailed for policy cancellation.
<br />City of Santa Ana
<br />Finance & Management Services Agency
<br />20 Civic Center Plaza
<br />Santa Ana, CA 92701
<br />ACORD 25 (2090105)
<br />SHOULD ANY OF THE ABOVE QNSCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIV51RED IN
<br />ACCORDANCE WITH THE POLICY PROVISICNS.
<br />AUTHORIZED REPREMNTATIVk
<br />June Larson JAUTT
<br />©'1988 -2010 ACORD CORPORATION. All rights reserved.
<br />INI5D2517mnrim m Thn Ar'r1Rrl nmmn and Innon,arn rnnicfnrne1 wmrha of Ar nPr5
<br />Pry- : A- 4..�f -0 CaH 7fTk"0`j 1 � F J IS"
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