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A40" h® CERTIFICATE OF LIABILITY INSURANCE <br />DAM(MMI DRYYYY ) <br />018 <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 have ADDITIONAL INSURED provisions or be endorsed. <br />If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on <br />this certificate does not confer rights to the certificate holder in lieu of such endomement(s). <br />PRODUCER <br />CONTACT <br />NAME: Erika Sokolik <br />Arthur J. Gallagher & Co. <br />Insurance Brokers Of CA Inc .LIC #0726293 <br />PNONE FAX <br />uC No Eat: 818-534-3558 LAIC, No:818-316-0990 <br />aooaEss: Edka Sokolik a' .com <br />21820 Burbank Blvd. Suite 175 <br />INSURERS AFFORDING COVERAGE <br />NAICN <br />Woodland Hills CA91367 <br />INSURER A: Insurance Company of the West <br />27a47 <br />INSURED <br />Downey Vendors .1 11 O2> <br />INSURER B : <br />6814 Suva Street I <br />Bell Gardens, CA 90201��� b, <br />/ <br />INSURERC: <br />INSURERD: <br />INSURER E: <br />INSURER F : <br />COVERAGES CERTIFICATE NUMBER: 1245914796 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 />ILTRR <br />TYPE OFINSURANCE <br />ADDL <br />SUER. <br />POLICY NUMBER <br />I POLICY EFF POLICY EXP <br />MMIDD/YYYY MWDDNM <br />LIMITS <br />COMMERCIAL GENERAL LIABILITY <br />EACH OCCURRENCE $ <br />TRENTED <br />Cl-AIMS-MADE1:1DAMAGE <br />OCCUR <br />PREMISES (Ea occurrence) _$ _ <br />MED EXP(Any one person) $ <br />PERSONAL &ADV INJURY $ <br />GEN'LAGGREGATE <br />LIMITAPPLIES PER <br />GENERAL AGGREGATE $ <br />POLICY _ PRO- <br />JECT J LED <br />PRODUCTS-COMP/OP AGO $ <br />OTHER. <br />$ <br />AUTOMOBILE <br />LIABILITY <br />COMBINED SINGLE LIMIT $ <br />(Ea accident <br />ANY AUTO <br />BODILY INJURY (Per person) $ <br />OPMED SCHEDULED <br />AUTOS ONLY AUTOS <br />BODILY INJURY (Per accident) $ <br />_ <br />HIRED NON-OMED <br />PROPERTY DAMAGE S <br />AUTOS ONLY AUTOS ONLY <br />(Peraccitlentl - <br />$ <br />UMBRELLAUAB <br />OCCUR <br />EACH OCCURRENCE $ <br />11 <br />EXCESS LIAB <br />CLAIMS -MADE_ <br />AGGREGATE $ <br />DED I RETENTION$ <br />S <br />A <br />WORKERS COMPENSATION 1 WVE503733301 726/2018 7262019 X PER OTH- <br />STATUTE ER_ <br />AND EMPLOYERS' LIABILITY <br />ANYPROPRETORIPARTNER/EXECUTIVE V� EL EACH ACCIDENT $1,OOgWO <br />OFFICERIMEM BER EXCLUDED'! NIA <br />(Mandatory in NH) E L DISEASE - EA EMPLOYEE $ 1pOg0D0 <br />If yyes, describe under -- --- <br />DESCRIPnON OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $1000,000 <br />DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is requir'tl� <br />Evidence of insurance only.e� f <br />�GgP <br />City of Santa Ana <br />20 Civic Center Sth Floor <br />Santa Ana CA 92702 <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 />/Z <br />9)1988-2015 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD <br />