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DRMAU -1 OP ID: C6 w., . CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDONM) 06/09/2015 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(les) 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 Brakke, Schafnitz Ins. Brokers License #0428915 100 Wilshire Blvd. 111940 Santa Monica, CA 90401 CONTACT NAME: Carole S. Mitchell PHON o - 0.310- 524 -1357 �� c Nea: 949- 313.3323 A" Og carole.mitchsII sig.us ADDRESS^ �i.. Darla Gray INSURERS AFFORDING COVERAGE W INSURER A:Westchester Surplus Lines Ins _NAIC ..,.__ X INSURED Dr. Maureen SassOOn ...._. P O Box 2028 Palos Verdes Peninsula, CA 90274 INSURER B: 0710112018 INSURER G: $ 50,000 X Add'I Insured INSURER D: INSURER_E; _ _ $ 5,000 INSURER F Prof & Pollut -CLM PERSONAL & ADV INJURY COVERAGES CERTIFICATE NUMBER: 1 REVISION NUMBER: THIS IS TO CERTIFY THA -r 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. IN R TYPEOFINSURANCE Tft L POLICY NUMBER MOCROYEFF PDMLLIICOYEYP LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE. $ 1,006,000 CLAIMS -MADE L�_"J OCCUR X X G24270427004 07/6112015 0710112018 PREMISES Eao curmnce $ 50,000 X Add'I Insured MED EXP (Any one Demon) $ 5,000 _ X Prof & Pollut -CLM PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2,000,00 X POLICY ❑JE4 LOG PRODUCTS- COMP/OPAGG $ 2,000,00 $ OTHER: AUTOMOBILE LIABILITY _ COMBINED SINGLE (Ea acelden0 $ BODILY INJURY (Par parson) $ ANYAUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (per accident) $ NON -OWNED HIREDAUTOS q AUTOS PR PERTYDAMA 'E_ Peraccident' $ UMBRELLA LIAO OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED RETENTION$ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOMPARTNERIEXECUTIVE O OPROERIMEMBER EXCLUDED? NIA I PER - STATUTE ER E.L. EACH ACCIDENT $ EL. DISEASE-EA EMPLOYE $ (Mandatary ho NN} It yes, describe under DESCRIPTION OF OPERATIONS bar. E.L DISEASE -POLICY LIMIT $ • Professional Liab. 624270427004 0710112015 0710112016 Prof.Liab 1,000,000 • Contractors Poll, G24270427004 0710112015 0710112016 Pollution 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be apaehed If more space la required) Policy Provides 30 days notice of cancellation except 10 days for nonpayment Applicable ndorsements Attached where required by Written Contract. Emailed @santa- ana.org CSANTAA SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City f Santa Ana THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN V Attn: Briza Morales ACCORDANCE WITH THE POLICY PROVISIONS. 20 Civic Center Plaza Santa Ana, CA 92701 AUTHORIZED REPRESENTATIVE ©1988 -2014 ACORD CORPORATION. All ri�ghAtsReSoryg4l.. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD tr'" L��