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s�coR[�e <br />CERTIFICATE OF LIABILITY INSURANCE <br />M (MMDDffTM <br />o 11115120 8 <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 <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 />DAVID I. REYES <br />StatBFdfln 1077 W 17th ST. STE B <br />-_ SANTA ANA, CA 92706 <br />'`LLT*.J��� <br />NAME: DAVID I REYES <br />FAX <br />I HO E ,714-285-0155 rve:714-648-1082 <br />,^ <br />ep sal . DAVID.I.REYES.EBBJ@STATEFARM.COM <br />INSURER(S)AFFORDING COVERAGE <br />NAIOM <br />INSURER A:5tate Farm General Insurance Company <br />76161 <br />INSURED FELIPE SOSA <br />1606 S BIRCH ST <br />SANTA ANA CA 92707 <br />NSURER B: <br />INSURER C: <br />INSURER D I <br />INSURER E; <br />INSURER F; <br />COVERAGES CERTIFICATE NUMBER: 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 />ILTN <br />TYPE OF INSURANCE <br />POLICYNUMBER <br />MMIDDYEPF <br />POLICYEXP <br />LIMITS <br />A <br />X <br />COMMERCIAL GENERAL LIABILITY <br />EACH OCCURRENCE <br />IS <br />CLAIMS -MADE Fx� OCCUR <br />PREMISES EA occ a Ce <br />IS <br />MEDEXP(Anyone parson) <br />$ S,000 <br />PERSONAL B ACV INJURY <br />$ <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />GENERAL AGGREGATE <br />S <br />POLICY PE T LOG <br />PRODUCTS-COMPIOP AOO <br />$ <br />OTHER: <br />Busn Property <br />$ <br />.AUTOMOBILE <br />LIABILITY <br />(ES EDSINGLE LIMIT <br />Eaa tlenl <br />$ 1,000,000 <br />BODILY INJURY (Par potion) <br />$ — 260,000 <br />ANY AUTO <br />5385534-D19.75 <br />10/1912019"' <br />074/19%2018' <br />BODILY INJURY (Pot accident) <br />$ 500,000 <br />AUTOS ED X 60HEDULED <br />HIRED AUTOS AUTOS <br />AUTOS MED <br />'- - <br />Per atodenl�MAGE <br />$ <br />dad 1000 <br />$ <br />UMBRELLA LWB <br />OCCUR <br />EACHOCCURRENCE <br />$ <br />AGGREGATE <br />$ <br />EXCESS LIAB <br />CLAIM64ADE <br />OED <br />RETENTION$ <br />$ <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY YIN <br />ANY PROPRIETORPARTNERIEXECUTIVE ❑NIA <br />OFFICERIMEMBER EXCLUDED4 <br />(Mandatary In NH) <br />STATUTE ER <br />E.L. EACH ACCIDENT <br />$ <br />EL. DISMS-EA EMPLOYE <br />$ <br />If yea, desaibe Under <br />OE SCRIPTIONOFOPERATIONSbelow <br />E.L. DISEASE -POLICY LIMIT <br />1 $ <br />DESCRIPTION OF OPERATIONS ILOCATIONSIVEHICLESIACORD701, Addifidnal Remarks Schedule. may as attuhod if mare apace Is mqulredl <br />��� <br />V.. <br />®sCIVN d�\� <br />0 a . <br />CERTIFICATE HOLDER CANCELLATION <br />Sonia Batres - Community events supervisor, <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANC BEFORE <br />Parks, Recreation & Community Services Agency <br />THE EXPIRATION DATE THEREOF, NOTICE WILL gr DELI RED IN <br />20 civic center plaza Santa ana ca 92701 <br />ACCORDANCE WITH THE P OVISIONS. <br />AUTHORIZED RESENTATIVE <br />RPO II right reserved. <br />ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD 1001486 132849.9 02.04.2014 <br />J <br />