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Ac'"R" CERTIFICATE OF LIABILITY INSURANCE
<br />DATE (MMIDDIYYYY)
<br />12/5/2018
<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: Ifthe certificate holder is an ADDITIONAL INSURED, the policy(ies) 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 />Southern California Insurance Brokerage
<br />3270 Inland Empire Blvd
<br />Suite 300, License #OK07568
<br />Ontario CA 91764
<br />NAME: Lisa Burrill
<br />PHONE (g09) 592-2215 FAx 9091305-0391
<br />AIC. No Ext): A1C, No
<br />E-MAIL certificates@socalinsurance.com
<br />ADDRESS:
<br />INSURER(S) AFFORDING COVERAGE NAIC 4
<br />INSURERA:Sentinel Ins. Co., LTD 11000
<br />INSURED
<br />David Taussig & Associates Inc., DBA: David Taussig & Ass
<br />5000 Birch St. #6000
<br />Newport Beach CA 92660
<br />INSURER B: California Auto Insurance Company. 38342
<br />INSURER C: National Union Fire Ins Co of Pitts, Pi 19445
<br />INSURER D: Property & Casualty Insurance Company c 34690
<br />INSURER E: Philadelphia Indemnity Ins. Co. 18058
<br />INSURER F:
<br />COVERAGES CERTIFICATE NUMBER:18/19 AUTO RENEWAL 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
<br />CERTIFICATE MAYBE 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 />DOLS
<br />INSD
<br />BR
<br />WVD
<br />POLICY NUMBER
<br />POLICY EFF
<br />MMIDDIYYYY
<br />POLICY EXP
<br />MMIDDIYYYY
<br />LIMITS
<br />X COMMERCIAL GENERAL LIABILITY
<br />EACH OCCURRENCE $ 2,000,000
<br />A
<br />CLAIM&MADE OCCUR
<br />D AG TO EN ED 1,000,000
<br />PREMISES Ea occurrence $
<br />MED EXP (Any one person) $ 10,000
<br />X
<br />72 SBA AP5439
<br />2/24/2018
<br />2/24/2019
<br />PERSONAL & ADV INJURY $ 2,000,000
<br />GENI AGGREGATE LIMIT APPLIES PER.
<br />GENERAL AGGREGATE $ 4,000,000
<br />POLICY Fx—] jE O F� LOC
<br />PRODUCTS - COMP/OP AGG $ 4,000,000
<br />$
<br />OTHER:
<br />AUTOMOBILE
<br />LIABILITY
<br />Ea accidents O $ 1,000,000
<br />BODILY INJURY (Per person) $
<br />B
<br />X
<br />ANY AUTO
<br />ALL OWNED SCHEDULED
<br />AUTOS AUTOS
<br />BA040000030599
<br />12/8/2018
<br />12/8/2019
<br />BODILY INJURY (Per accident) $
<br />NON -OWNED
<br />HIREDAUTOS AUTOS
<br />PROPERTY DAMAGE $
<br />Per accident
<br />Unlnsured/Underinsured Motorist BI $ 1,000,000
<br />UMBRELLA LIAR
<br />X_
<br />OCCUR
<br />EACH OCCURRENCE $ 2,000,000
<br />AGGREGATE $ 2,000,000
<br />C
<br />X
<br />EXCESSLIAB
<br />CLAIMS -MADE
<br />X
<br />DED RETENTION $
<br />$
<br />eau 080755754
<br />2/24/2018
<br />2/24/2019
<br />WORKERS COMPENSATIONFIER
<br />ANDEMPLOYERS'LIABILITY YIN
<br />U -
<br />STATUTE ER
<br />E L EACH ACCIDENT $ 1,000,000
<br />ANY PROPRIETOR/PARTNER/EXECUTIVE
<br />D
<br />OFFICER/MEMBER E(CLUDED7 ❑
<br />(Mandatory In NH)
<br />N f A
<br />72 wEc Eu2873
<br />9/1/2018
<br />9/1/2019
<br />EL.DISEASE- EAEMPLOYEE $ 1,000,000
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE - POLICY LIMIT $ 1,000,000
<br />E
<br />Prof. Liab. —claims made
<br />PHSD1391520
<br />11/1/2018
<br />11/1/2019
<br />$2,000,000
<br />F
<br />Crime
<br />72 BDDHP8140
<br />6/14/2018
<br />6/14/2019
<br />$1,000,000
<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 REPRESENTATIVE ARE NAMED AS ADDITIONAL
<br />INSURED IN REGARDS TO GENERAL LIABILITY.
<br />-A/I ATTACHED.
<br />REVIEWED BY: EUNICE HEREDIA (PG
<br />CERTIFICATE HOLDER CANCELLATION
<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 REPRESENTATIVE
<br />Burrill, CISR/CERTS
<br />0) 19RR-7014 ACORD CORPORATION- All rinhtc rpcprvprl
<br />ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD
<br />IN S025 (20140 1)
<br />
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