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.2D /4l- ls' <br />A� & CERTIFICATE OF LIABILITY INSURANCE <br />03/25/2016 ) <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 />Millennium Corporate Solutions <br />CONTACT <br />NAME: Tune Larson <br />PHONN (949)679 -6606 /X NOt (949)679 -6906 <br />AI: <br />License # OC13480 <br />E -MAIL <br />ADDRESS: j /arson ®mcaina.com <br />5530 Trabuco Road <br />INSURERS AFFORDING COVERAGE <br />NAIC# <br />INSURER A:Hanover Insurance <br />22292 <br />Irvine CA 92620 <br />INSURED <br />INSURER B:Underwriters at Lloyds <br />15792 <br />INSURER C: <br />Fieldman, Rolapp & Associates, Inc. / <br />19900 MacArthur Blvd. #1100 ✓ <br />INSURER D: <br />INSURER E <br />DAMAGE TO RE TED <br />PREMISES Ea occurrence <br />$ 11000,000 <br />1 INSURER F: <br />MED EXP(Any one person ) <br />Irvine CA 92612 -2445 <br />I/ <br />r/ <br />COVFRAGFR CFRTIFICATF NIIMRFR-Renewal Master RFvl -glnId NIInnRFR• <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 INSURANCE <br />ADDL <br />JUM <br />SUBR <br />WVD <br />POLICY NUMBER <br />POLICY EFF <br />POLICY EXP <br />MMIDDfYYYY1 <br />LIMITS <br />X <br />COMMERCIAL GENERAL LIABILITY <br />EACH OCCURRENCE <br />$ 11000,000 <br />A <br />CLAIMS -MADE � OCCUR <br />DAMAGE TO RE TED <br />PREMISES Ea occurrence <br />$ 11000,000 <br />MED EXP(Any one person ) <br />$ 10,000 <br />OH3 A578667 00 <br />4/1/2016 <br />4/1/2017 <br />PERSONAL& ADV INJURY <br />$ 11000,000 <br />GEN'L AGGREGATE LIMIT APPLIES PER', <br />GENERAL AGGREGATE <br />$ 2,000,000 <br />X POLICY JECT ❑LOC <br />ECT <br />PRODUCTS - COMP /OP AGO <br />$ 2,000,000 <br />Employee Benefits <br />$ 11000,000 <br />OTHER: <br />AUTOMOBILE <br />LIABILITY <br />) GLE LIMIT <br />$ 1, 000, 000 <br />RY(Per person) <br />$ <br />A <br />ANY AUTO <br />ALL OWNED SCHEDULED AUTOS AUTOS <br />OH3 A578667 00 <br />4/1/201fi <br />9/1/201URV <br />7C;OMBINED <br />(Per accltlent) <br />$ <br />X <br />NON-OWNED <br />HIRED AUTOS X AUTOS <br />DAMAGE <br />t <br />$ <br />X <br />UMBRELLA LIAB <br />OCCUR <br />EACH OCCURRENCE <br />$ 3,000,000 <br />AGGREGATE <br />$ <br />A <br />EXCESS LIAB <br />CLAIMS -MADE <br />DED RETENTION$ <br />$ <br />JOH3 A578667 00 <br />4/1/2015 <br />4/1/2017 <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY YIN N <br />ANY PROPRIETOWPARTNERIEXECUTIVE ❑ <br />OFFICERIMEMBER EXCLUDED? <br />NIA <br />PER OTH- <br />STATUTE ER <br />E.L. EACH ACCIDENT <br />$ <br />E.L. DISEASE - EA EMPLOYE <br />$ <br />(Mandatory In NH) <br />If yes, describe under <br />DESCRIPTION OF OPERATIONS below <br />E.L. DISEASE - POLICY LIMIT <br />$ <br />B <br />Profe6Bional Liability <br />SUAWS200491502 <br />12/20/2015 <br />6/19/2017 <br />Aggregate $2,000,000 <br />Retro Date 12/20/2004 <br />Claims Made Policy <br />Retention $250,000 <br />DESCRIPTION OF OPERATIONS I LOCATIONS /VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached If more space Is required) <br />The City of Santa Ana, it's officers, employees, agents and representatives are named as additional <br />insured as per form attached. <br />30 days notice shall be mailed for policy cancellation. <br />CERTIFICATE HOLDER CANCFI I ATION <br />©1988.2014 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD br is ('Am iers <br />I NS0251201401 I <br />PS <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />City of Santa Aria <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />Finance & Management Services Agency <br />ACCORDANCE WITH THE POLICY PROVISIONS, <br />20 Civic Center Plaza <br />AUTHORIZED REPRESENTATIVE <br />Santa Ana, CA 92701 <br />June Larson /JUNE <br />©1988.2014 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD br is ('Am iers <br />I NS0251201401 I <br />PS <br />