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N-2018-102-01 A� �' CERTIFICATE OF LIABILITY INSURANCE D09/24/2018Y) THIS CERTIFICATE IS ISSUED AS A 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(les) must 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 Eddie Quillares Jr. State Farm Agency IN N. Broadway San Santa Ana, CA 92701 I'UNT: D Eddle QUlllares P80NC FAX c No Ext: 714.617.7150. Alc NO: 14.617.7150 AooalEss eddie eddie insurance.com WSURERSAFFORDING COVERAGE NAIL INSURER A: State Farm General Insurance Com an 25151 INSURED Yenny Bernal DBA Uplifting Soul Art Events 1052 W Pine St Santa Ana, CA, 92703 INSURER B: INSURER C: INSURER D: INSURER E, INSURER F: COVERAGES CERTIFICATE NUMBER: 75-0450 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 RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, LTR TYPE OF INSURANCE INSR VAID POLICYNUMBER POLICY EFF MMIDONYYY LIMITS A GENERAL LIABILITY Y 92 -EX -K512-8 05/06/2016 05/06/2019 EACHOCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY CLAIMS-MADEOCCUR AI\A ETO RENTE PREMISES Ea occurrence$ 300,000 MED EXP(Anygnepercon) $ 5,000 PERSONAL &ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATELIMIT APPLIES PER'. PRODUCTS - COMPIOP AGO $ 2,000,000 POLICY JRCOT LOC $ AUTOMOBILE LIABILITY ❑❑ COMBINEU SINULL UMHT BODILY INJURY ((Per person) $ ANY AUTO ALL OWN ED SCHEDULED AUTOS AUTOS BODILY INJURY(Peraccideul) $ HIRED AUTOS NON -OWNED AUTOS PROPERTY DAMAGE Par accitlanl 5 UMBRELLA LIAB OCCUR ❑ EACH OCCURRENCE $ EXCESSUAS CLAIMS -MADE AGGREGATE 5 DED RETENTION$ 10,000 $ WORKERS COMPENSATIONWC STATU- OTH- AND EMPLOYERS' LIABILITY YIN ANY PROPMETORIPARTNEWEXECUTIVEE.L. OFFICEIMEMBER EXCLUDED? ❑ NIA❑ TO V R EACH ACCIDENT $ E.L. DISEASE -EA EMPLOYE $ (Mandatory In NH) It yoa, d.'re under E.L. DISEASE -POLICY LIMIT $ $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Adach ACORDi01,Additlonal Remarks Schedulo,Ifmarospoce le required) THE CITY OF SANTA ANA, ITS OFFICERS, EMPLOYEES, AGENTS, AND REPRESENTATIVE ARE NAMED AS ADDITIONAL INSURED IN REGARDS TO GENERAL LIABILITY PER ATTACHED EXHIBIT B ADDITIONAL INSURED FORM. CERTIFICATE HOLDER CANCELLATION CITY OF SANTA ANA SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 20 CIVIC CENTER PLAZA ACCORDANCE WITH THE POLICY PROVISIONS. SANTA ANA, CA 92701 AUTHORIZED REPRESENTATIVE Au ill SONIABATRES ©1988-2010 ACDRD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD 1001486 132849.7 03-01-2012 Sioey%'W'« Ove YIe`ict Page-"