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6.A. - Page 37 of 50 Section 10 — Insurance DAC The following is a specimen copy of a certificate of liability document evidencing DAC's insurability and liability limits. A� o® CERTIFICATE OF LIABILITY INSURANCE DATE(MM{DDIYYYY) 03114x2018 THIS CERTIFICATE IS ISSUED ASA 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(ies) must have ADDITIONAL INSURED provisions or 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 CONTACT Coil Provo NAME: Assured Partners of Minnesota LLC AIe E Ext: (651)644-7200 q7[, No: (651)6449137 2361 Highway 36 West E-MAIL cprovo@apminnesoia.com ADDRESS: INSURER(S) AFFORDING COVERAGE NAIL 0 COMMERCIALGENERALLIABILITY INSURER A: National Fire Ins Co of Hartford 20478 St. Paul MN 55113 INSURED INSURER 8: Valley Forge Ins Co 20508 Disability Access Consultants, LLC INSURER C: Transportation Ins Co 20494 2243 Feather River Blvd INSURER D: Wesco Insurance Co INSURER E: Philadelphia Insurance Company 251 INSURER F: Orovllle CA 95965 COVERAGES CERTIFICATE NUMBER: 18119 Master REVISION NUMBER: THIS IS TO CERTIFY THAT 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 RESPECTTO WHICH THIS CER71FICATE MAYBE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS 5UBJECTTO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES_ LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR TYPE FINSURANCE INSD Wv0 POLICY NUMBER MMIDONYYY POLICY EXP MMIDDIYYYY LIMITS COMMERCIALGENERALLIABILITY EACH OCCURRENCE $ 2,000,000 �/ DAMAGE TO RENTED 300,000 PREMISES Ea occurrence $ 1:11.1.11LX OCCUR MEDEXP(Anyoneperson) $ 10'000 PERSONAL&ADV INJURY $ 2,000,000 A B6020052587 0110112018 01/01/2019 GEN'LAGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE g 4.000,000 X POLICY ❑ JE -T ❑ LOC PRODUCTS -COMPIOP AGG $ 4'000'000 Employee Benefits $ 1,000,000 OTHER. AUTOMOBILE LIABILITY C0rr1,B NED 5INGLE LIMIT $ 1 QQO DDC)v Ea accident BODILYINJURY[Perperson] $ ANYAUTO B OWNED SCHEDULED AUTOS ONLY AUTOS B6020004782 0110112018 01101X2019 BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ Peraxltlenf HIRED NON -OWNED AUTOS ONLY AUTOS ONLY Medical payments $ 5,000 X UMBRELLALIAB X OCCUR EACH OCCURRENCE $ 5'000'000 AGGREGATE $ 5,000,000 C ExcE55LIAR CLAIMS -MADE B6020052637 0110112018 0110112019 X1 DED RETENTION $ 0 $ WORK ERS COMPENSATION PER OTH- STATUTE ER ANDEMPLOYERS'LIABILITY Y! N EL EACH ACCIDENT $ 1.000.000 D ANYPERNE ❑ NIA WWC3324879 01!0812018 01106!2019 1,000,000 E.L. DISEASE -E4 EMPLOYEE $ SRIPARTNERlIXECUTNE Oandall,EMBER EXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS bs1c. EL.DISEASE - POLICY LIMIT $ 1,000,000 Professional Liability E PHSD1316595 03/1312018 03/13/2019 Limit $5,000,000 Deductible $10,000 DESCRIPTION OFOPERATIONS 1 LOCATIONS 1 VEHICLES )ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) CERTIFICATE HOLDER CANCELLATION SPECIMEN CERTIFICATE SHOULD ANY OF THEABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WALL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE A. © 1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD DAC Response to the City of Redwood City for ADA Consulting Services 14 43