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ACORbP VEHICLE OR EQUIPMENT CERTIFICATE OF INSURANCE <br />lla� <br />oA EpRmmon YYl <br />10511112018 <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 />This form Is used to report coverages provided to a single specific vehicle or equipment. Do not use this form to report liability coverage <br />provided to multiple vehicles under a single policy. Use ACORD 25 forthat purpose. <br />PRODUCER <br />6WOMT@AC Sarlah Devereaux <br />$}afeFarM Sarlah Devereaux-Bavientos <br />of nl: 714.541.7280 ---..F�.Ro, 714-384-3892 <br />State Farm Agent WW <br />E'MA sariah@71454117260.com <br />1202 W 1st St <br />PUE�U& OF33249 <br />INSUR@ S AFFORDING COVERAGE} <br />NAIC4 <br />Santa Ana CA 92703 <br />INSURED <br />INSURERA • State Farm Mutual Automobile Insurance Company <br />25178 <br />Roberto Zavala Cardenas <br />INSURER 0, <br />14132 Kerry at <br />INSURER C:y <br />`� <br />INSURER D: <br />Garden Grove CA 92844 <br />I s NER . <br />I.1�iF1:I1JtIL�P [e]�TI4CICdS3eT:� <br />YEAR MAKEIMANUFACTURER MDOEL <br />eODY TYPE <br />VEHICLE IDENTIFICATION NUMBER <br />1994 GMC 3500 <br />Box TrucK <br />IGOKC34N9RJ519011 <br />DESCRIPTION <br />VEHICIFJEOUIPMENT VALUE <br />SERNLNUMBOR <br />is <br />COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: <br />THIS IS TO CERTIFY THATTHE POLICY(IES) OF INSURANCE LISTED BELOW HASIHAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY <br />PERIOD(S) INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO <br />WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICY(IES) DESCRIBED HEREIN ISIARE SUBJECT TO <br />ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICY(IES). <br />a1SR <br />ADcL <br />POUCYEFFECTIVE <br />POLICYEKPIRATION <br />LTR <br />Near <br />TYPEOFINSURANCE <br />POLICY NUMBER <br />OATE(MMOVA'YYY) <br />PATE(MMIDDNVYY) <br />LIMITS <br />X VINANNALMBILITY <br />COMBINED SINGLE LIMIT <br />It <br />A <br />1957791F-12.75E <br />12/1212017 <br />12112/2018 <br />BODILY INJURY (Per parson) <br />81000,000 <br />BODILY INJURY (Per Ia ldard) <br />3 1,000,000 <br />PROPERTYDAMAGE <br />I 11000,000 <br />O ENERAL LIABILITY <br />EACHOCCURENCE <br />It <br />OCCURRENCE <br />GENERALAGGREGATE <br />I <br />CLAIMS MADE <br />$ <br />INSR <br />Nee <br />POLICY EFFECTIVE <br />POLICYMPIRATION <br />LTR <br />AYES <br />TYPa OFINSURANCE <br />POLICY NUMBER <br />DATE(MMIOOIYYYY) <br />DATE(MIAUDRYYY) <br />UMITSIDEDUOTIBLE <br />VEH COLLISION LOSS <br />a❑ ACV Cl AGREED AMT <br />3 LIMO <br />❑ ❑STATED ANT <br />3 Bad <br />VEHCOMP VEH OTC <br />❑i ACV ❑AGREED ANT <br />3 UNIT <br />�.i. <br />❑ ❑STATEDAMT <br />3 Dan <br />EQUIBASIC PMENT---- <br />.t 1.(') i <br />❑ ACV ❑ AGRBBDAMT <br />BROAD <br />.\\V <br />a RC ❑ STATED AM3 <br />3 LIMIT <br />DED <br />Q`��\ <br />hfi <br />�,.(�� <br />oe <br />REMARKS (INCLUDING SPECIAL CONDITIONS I OTHER COVERAGES) (AtMeh RO tOLAAdd l Retneres Schedule, it rnon epaaela nquu d) <br />Comprehensive deductible: 100: collision deductible: 800; Uninsured Mot st protection 250,0001500,000 <br />of one of the folluwlnet <br />The adds c ul InUMH doeaibed edow Ass been added to the pdig(lee) Baled herein by policy mrMb,d.s . <br />A regw+pt hap pawn p�mllted'0 a_Id the Juon°I interost deaaribed bat . M the Parcylies) <br />VEHICLE I EQUIPMENT INTEREST; I I LEJUAO I FINANCED <br />NAME AND ADDRESS OF ADDITIONAL INTEREST i F <br />CITY OF SANTA ANA <br />20 CIVIC CENTER PLAZA <br />SANTA ANA, CA 02701 <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED <br />BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE <br />DELIVERED IN ACCORDANCEWITH THE POLICY PROVISIONS. <br />ADDRIONAL INSURED LOSE PAYEE <br />LENDER'S L098 PAYEE (—'— <br />LOAN ILEASE NUMBER A <br />AUTHORIZED <br />ACORD 23 (2016103) The ACORD name and logo are registered marks of ACORD` L", <br />100/381 142aeT.3 018&418 <br />