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N-2018-151
<br />`6 �'r CERTIFICATE OF LIABILITY INSURANCE
<br />006/2812018 ATE Y)
<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 />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(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the
<br />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 Eddie QUlllares Jr.
<br />ACT
<br />NAME: Eddie Quivares
<br />State Farm Agency
<br />IAIc N Ext): 7146177150 _.... 1 (F Not 714.6177158 _..
<br />415 N. Broadway
<br />EMAIL
<br />ADDRESSeddle@eddieginsurance.com
<br />OSanta Ana, CA 92701
<br />INSURERS AFFORDING COVERAGE NAIL#
<br />LIMITS
<br />A
<br />INSURERA. State Farm General Insurance Company 25151
<br />INSURED DOWNTOWN INC
<br />INSURER B: State Farm Fire and Casualty Company 2543
<br />INSURER C:
<br />200 N MAIN ST FL 2
<br />INSURER D:
<br />SANTA ANA CA 92701
<br />INSURER E
<br />$_ _ 1,000,000
<br />INSURER F:
<br />COVERAGES CERTIFICATE NUMBER: 75-0450 REVISION NUMBER:
<br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
<br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS,
<br />INSR
<br />ADDLSUBR
<br />POLICY EFF
<br />POLICY EXP
<br />LTR
<br />TYPE OF INSURANCE
<br />POLICYNUMBER
<br />MMIDDIYYYY
<br />MMIDUNYYY
<br />LIMITS
<br />A
<br />GENERAL
<br />LIABILITY
<br />�Y
<br />❑Y
<br />92•CE-0933.0
<br />06/05/2018
<br />.0610512019
<br />EACH OCCURRENCE _
<br />$_ _ 1,000,000
<br />MERCIAL GENERAL LIABILITY
<br />15REMISESRENTED
<br />PREMISES He occurrence
<br />$ 300,000
<br />CLAIMS -MADE n OCCUR
<br />T
<br />MEDEXP(Anycne person)
<br />$ 5,000
<br />PERSONAL& AOI INJURY
<br />$ 1,000,000
<br />GENERAL AGGREGATE
<br />$ 2,000,000
<br />GEN'L AGGREGATELIMIT
<br />APPLIES PER'.
<br />PRODUCTS - COMPIOP AGO
<br />$ 2,000,000
<br />PRO
<br />POLICY
<br />LOU
<br />$
<br />A
<br />AUTOMOBILE LIABILITY
<br />�
<br />u
<br />75-0450-X94
<br />06/28/2016
<br />12/28/2016
<br />COMBINED SINGLE LIMIT
<br />Ea arddent
<br />$
<br />ANYAUTO
<br />BODILY INJURY (Par person)
<br />$
<br />..__ ALL OWNED r_-. SCHEDULED
<br />X S$
<br />AUTOS AUTO
<br />ALLHIREOWUTOS
<br />----_____._____...........
<br />BODILY INJURY (Per accldanl)
<br />_ _1000000_
<br />_
<br />1,000,000
<br />NUT6S EO
<br />IAUTOS
<br />PROPERLY DAMAGE
<br />$ 1,000,000
<br />_
<br />'
<br />oil
<br />Comp/Coll Ded
<br />Comp/
<br />� $ 250
<br />A
<br />X
<br />--
<br />UMBRELLA LIAR '.X OCCUR
<br />—
<br />❑Y
<br />92•CE-0781-7
<br />06/05/2018
<br />06/05/2019
<br />EACN OCCURRENCE
<br />$ 1,000,000
<br />EXCESSUABCLAIMS-WADE
<br />AGGREGATE
<br />$2,OOQ00
<br />OED X RETENTION$ 10,000
<br />$
<br />B
<br />WORKERS COMPENSATION
<br />WC STATU- OTH-
<br />X
<br />1,000,000
<br />AND EMPLOYERS' LIABILITY
<br />92 -LH -2053.2
<br />06105/2018
<br />06/05/2019
<br />--LI LIMITS eq
<br />_,
<br />YIN
<br />ANY PROPRIETORIPARTNERIEXECUTIVE
<br />OFFICEIMEMBER EXCLUDED? Y❑
<br />NIA
<br />Y
<br />❑
<br />E L EACH ACCIDENT
<br />$ 1,000,000
<br />11Mantlatory In NH)
<br />E.L. DISEASE- EAEMPLOYE
<br />$ 1000,000
<br />If,, tlesollbe under
<br />BlC1QN QE QEEL61IONS helps
<br />E. L. DISEASE - POLICY LIMIT
<br />$ 1,000,000
<br />A
<br />l FIDELITY BOND
<br />❑
<br />92-WV•6044.5
<br />10/03/2017
<br />10/03/2018
<br />BUND -AMOUNT $ 500,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required)
<br />City of Santa Ana its officers, agents, employees and volunteers are named as additional insured.
<br />Additional Insured endorsement issued for certificate holder with Wavier of Subrogation and non-contributory
<br />CITY OF SANTA ANA
<br />20 CIVIC CENTER PLAZA SANTA ANA, CA 92702
<br />ATTENTION RISK MANAGEMENT
<br />BRIZA MORALES
<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 />ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD 1001486 132849.7 03-01-2012
<br />
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