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ACC>R" CERTIFICATE OF LIABILITY INSURANCE
<br />F DATE(MM /DD/YYYY)
<br />`,.... -�" 7/1/2017
<br />1 8/30/2016
<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(ies) must have ADDITIONAL INSURED provisions or be endorsed.
<br />If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on
<br />this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
<br />PRODUCER LOckton Companies
<br />CONTACT
<br />444 W. 47th Street, Suite 900
<br />PHONE FAX
<br />Kansas City MO 64112 -1906
<br />A/C No Ext : A/C N-)-
<br />E -MAIL
<br />(816) 960 -9000
<br />ADDRESS:
<br />INSURER(S) AFFORDING COVERAGE NAIC 1<
<br />DAMAGES (RENTED
<br />PREMISES Ea occurrence )
<br />INSURER A: LM Insurance Corporation 33600
<br />INSURED NELSON \NYGAARD CONSULTING ASSOCIATES, INC.
<br />INSURER B: Endurance Risk Solutions Assurance Co 43630
<br />INSURER C : LIo ds &London Co Para on-Lcnndtan _
<br />Y
<br />1417985 116 NEW MONTGOMERY STREET, STE., 500
<br />SAN FRANCISCO CA 94105
<br />INSURER D: Liberty Mutual Fire Insurance Company 23035
<br />INSURER E :
<br />INSURER F:
<br />COVERAGES CERTIFICATE NUMBER: 14241328 REVISION NUMBER: XXXXXXX
<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 />D
<br />SUBR
<br />.. POLICY EFF
<br />POLICY NUMBER MM /DD /YYYY
<br />POLICY EXP
<br />MM /DDNYYY
<br />LIMITS
<br />D
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE � OCCUR
<br />Y
<br />N
<br />TB2661066787026 ' 9/1/2016
<br />7/1/2017
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />DAMAGES (RENTED
<br />PREMISES Ea occurrence )
<br />$ 1,000,000
<br />MED EXP (Any one person)
<br />1.0 000
<br />PERSONAL & ADV INJURY
<br />_$
<br />_$I 000,000
<br />AGGREGATE LIMIT APPLIES PER:
<br />—
<br />GENERAL AGGREGATE
<br />$ 2,000,000
<br />GEN'L
<br />-
<br />POLICY X. PRO-
<br />JECT LOC
<br />PRODUCTS - COMP /OP AGG
<br />$ 2,000,000....
<br />OTHER:
<br />$
<br />D
<br />AUTOMOBILE
<br />LIABILITY
<br />Y
<br />N
<br />AS2661066787016 '...9/1/2016
<br />7/1/2017
<br />COMBINED SINGLE LIMIT
<br />Ea accident
<br />$ 1,000,000
<br />BODILY INJURY (Per person)
<br />$ XXXXXXX
<br />X
<br />ANY AUTO
<br />'.......
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />BODILY INJURY (Per accident)
<br />$ XXXXXXX
<br />X
<br />HIRED NON -OWNED
<br />AUTOS ONLY X AUTOS ONLY
<br />'..
<br />__
<br />PROPERTY DAMAGE
<br />Per accident
<br />$ XXXXXXX
<br />$ XXXXXXX
<br />''..
<br />B
<br />UMBRELLA LIAB
<br />}{
<br />OCCUR
<br />N
<br />N
<br />EXCI0007112701 9/1/2016
<br />7/1/2017
<br />EACH OCCURRENCE _ _
<br />s 6,000,000
<br />is
<br />X
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />AGGREGATE
<br />.,
<br />6,000,000
<br />DED RETENTION $
<br />Is XXXXXXX
<br />A
<br />WORKERS COMPENSATION Y/N
<br />AND EMPLOYERS' LIABILITY
<br />ANY PROPRIETOR /PARTNER /EXECUTIVE
<br />OFFICER /MEMBER EXCLUDED?
<br />N / A
<br />N
<br />WC5661066787036 9/1/2016
<br />7/1/2017
<br />X STATUTE ER
<br />THEOO
<br />E.L. EACH ACCIDENT
<br />E.L. DISEASE - EA EMPLOY
<br />(Mandatory in NH)
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE - POLICY LIM
<br />C
<br />PROFESSIONAL
<br />N
<br />N LDUSA1601441 9/1/2016
<br />7/1/2017
<br />$5,000,000 PER CLAIM; $5,000,000
<br />LIABILITY
<br />AGGREGATE
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached It more space is required)
<br />GENERAL LIABILITY POLICY EXCLUDES CLAIMS ARISING OUT OF THE PERFORMANCE OF PROFESSIONAL SERVICES. RE: ALL OPERATIONS OF THE
<br />NAMED INSURED. CITY OF SANTA ANA, ITS OFFICERS, EMPLOYEES, AGENTS, VOLUNTEERS AND REPRESENTATIVES ARE ADDITIONAL INSUREDS AS
<br />RESPECTS TO GENERAL LIABILITY AND AUTO LIABILITY, AND THESE COVERAGES ARE PRIMARY, AS REQUIRED BY WRITTEN CONTRACT. THE
<br />ADDITIONAL INSUREDS' OWN COVERAGE IS EXCESS OF AND NON - CONTRIBUTORY WITH THE GENERAL LIABILITY, AND ON THE AUTO LIABILITY AS
<br />RESPECTS TO VEHICLES OWNED BY NELSON \NYGAARD CONSULTING ASSOCIATES, INC.
<br />�P
<br />�..
<br />a,cn I Iri%,A I e nvLUCn I,AIVI.rCLLA I IVIV oee iAttaCniTients ( AP69 "" I & 1
<br />14241328
<br />CITY OF SANTA ANA
<br />20 CIVIC CENTER PLAZA
<br />SANTA ANA CA 92701
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />AUTHORIZED
<br />©1988L+2015 ACORD CORPORATION- All rinhta raaarwarl
<br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
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