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667979 .Miller Mendel, Inc. Certificate of Insurance (page 1 of 1) 01/12/2016 05:22:36 PM
<br />,al�C>RiY CERTIFICATE OF LIABILITY INSURANCE
<br />TE PMMIDay)Yvj
<br />DA1/1212016
<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: It the certlficate holder is an ADDITIONAL INSURED, the policy(les) must be endorsed, If SUBROGATION IS WAIVED, allbloot t0
<br />the terms and conditions of the policy, certain policies may require an endorsement. A statement on this oeritloate does not confer rights to the
<br />certificate holder in lieu of such endorssment(s).
<br />PRODUCER
<br />TACT
<br />Techlnsurance
<br />o s 1301 Central Ex South, Suite 115
<br />:c'MichIInsurance py.
<br />Allen, TX 75013
<br />PNoNS . r, 800.6887020 nlc No: 877)826.9087
<br />&MAIL
<br />ADD Ess.
<br />PRODUCER
<br />9TOM R104•
<br />INSURERS AFFORDING COVERAGE
<br />NAICN
<br />INSUR90 d
<br />Miller Mendel, Inc N-OP016 r
<br />INSURERA: Beaze Insurance Company Inc
<br />37540
<br />INSURER B: Sentinel insurance Company, Limited
<br />11000
<br />INSURER C:
<br />1426 Broadway Ste 430
<br />Seattle, WA 86122
<br />INSURER D
<br />MED EXP(Any one person) $ 10.000
<br />INSURER E;
<br />0
<br />INSURER F:
<br />I� J
<br />COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
<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 />IITF
<br />TYPE Of INSURANCE
<br />AODLSUBR
<br />AUTHORIZED REPRESENTATIVE
<br />POLICY NUMBER
<br />POLICY EFF
<br />MMIDWYYYY
<br />POLICY E%P
<br />WMIDO/YWVY
<br />LIMITS
<br />GENERAL LIABILITY
<br />EACHOCCURRENCE_ $ 1,060,000
<br />✓ COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE [71 OCCUR
<br />MAGE TO
<br />OPREMISES ?occurr nnq $ 1,000,000
<br />MED EXP(Any one person) $ 10.000
<br />PERSONAL&ADVINJURY $ 1,000,000
<br />STOP GAP(see below forlimits)
<br />Yes
<br />465 3MUF41 IS
<br />12/26/2015
<br />12126/20/0
<br />GENERAL.AGGREGATE $ 2,000,000
<br />GEN 1. AGGREGATE
<br />LIMIT APPLIES PER:
<br />PRODUCTS. COMP/OP AGO $2,000,000
<br />$
<br />—✓ POLICY
<br />'f 7 LOC
<br />AUTOMOBILE
<br />LIABILITY
<br />COMBINED SINGLE LIMIT s 1,000,000
<br />(Ea accidsnH
<br />ANY AUTO
<br />BODILY INJURY (Per person) 6
<br />e
<br />✓
<br />ALL DINNED AUTOS
<br />SCHEDULED AUTOS
<br />HIRED AUTOS
<br />Yes
<br />40SBMUF4112
<br />12/2912015
<br />12126/2016
<br />BODILY INJURY (Per accident) $
<br />--
<br />PROPERTY DAMAGE_ S
<br />(Peracdi ent)
<br />$
<br />✓
<br />NON -OWNED AUTOS
<br />$
<br />UMBRELLA LIAROCCUR
<br />EACH OCCURRENCE $
<br />AGGREGATE $
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />DEDUCTIBLE
<br />$
<br />_
<br />$
<br />RETENTION .$
<br />WORKERS COMPENSATION
<br />WC S7ATU- OTH-
<br />B
<br />ANO EMPLOYERS' LIABILITY
<br />ANY PROPRIFTORIPARTNEP./EXECUTIVE �Y'I"NT
<br />OFFICER/MEMBF,R EXCLUDSD4 LJ
<br />(Mandatory in NH)
<br />NIA
<br />46SUMUF'4112 (STOP GAP)
<br />12/2&2015
<br />12126/2016
<br />E.L. BACH ACCIDENT $ 1,000,000
<br />E.L. DISEASE- EA EMPLOYEE $ 1,0K000
<br />1 aa, denolbe under STOPGAP
<br />DR SC RI PTION OF OPERATIONS below
<br />E, L., DISEASE. POLICY LIMIT $ 1,000,000
<br />A
<br />Prohesional Liability (E ... 4 and Omisaions)
<br />V177D7150201
<br />12/26/2016
<br />12/26/2016
<br />$1,000,000/$1,000,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks SChedula, If ov, O space Is squired) �,�j/_ ,� /
<br />City of Santa Ana is named as Additional Insured as their interests may appear [II regards to general liabbbiilliit/y/ a utomob' Iiab111ty/6J.0l"i
<br />�t/CU/A'/11
<br />T d
<br />CERTIFICATE HOLDER CANCELLATION N ''i Lf r
<br />© 1988.2014 ACORD CORPORATION. All rights reserved.
<br />ACORD 26 (2014/01) The ACORD name and logo are registered marks or ACORD
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />City of Santa Ana
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />20 Civic Center Plaza
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />Santa Ana, CA 92701
<br />AUTHORIZED REPRESENTATIVE
<br />--
<br />© 1988.2014 ACORD CORPORATION. All rights reserved.
<br />ACORD 26 (2014/01) The ACORD name and logo are registered marks or ACORD
<br />
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