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1 <br />CERTIFICATE OF LIABILITY INSURANCE DATE(MMRIDNM) <br />10/1912018 <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br />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), <br />AUTHORIZED <br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. <br />IMPORTANT: If the cartincerte hoidar is an ADDITIONAL INSURED, the pDllcy(les) must have ADDITIONAL INSURED provlslons or be endorsed. <br />H SUBROGATION IS WAIVED, subject to the terms and conditions of the p011cy, Certain policies may require an ondomement. A statement on <br />this Cortiflcate does not confer rights, to the certificate holder In lieu of such endorsements . <br />PRODUCER <br />GO TACT <br />$WeFarM ROY JEFFERSON, AGENT <br />PONE <br />714-283.6336 PAx 7 44-283.5941 <br />"")royI lee N r <br />116 S CHAPARRAL CT, SUITE 260 <br />Ai: M L �royjaHeraon.net <br />�- <br />10 ANAHEIM, CA 92805 <br />INSUREMS) <br />APFORBING COMCOmpany <br />C0 <br />1 s RERA: State Farm General Insuranc51 <br />1xsuREo <br />INs Rare a: State Farm Mutual Automobil78AIMTD <br />LLC -INSURERC: <br />751 WEIR CANYON ROAD, SUITE 157.158INSURER <br />2 <br />DANAHEIM, <br />CA 92808 <br />1�teURER <br />INSUR RF: �_ <br />nc NAMED rgOVE F01 <br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED A60VE FOR <br />THE POLICY PERIOD <br />INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO VM ICH THIS <br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />ItI SR <br />TYPE OFINSURANCE <br />AO <br />bR <br />P LICYN MB <br />PO C <br />PD YEYP <br />MDrYYrIn <br />-�—�— <br />LOU _-- <br />XI <br />COMMERCIAL GENERAL LIABILITY <br />EACH OCCURRENCE <br />f 2,000,000 <br />f 2.000,000 <br />CLAIMS -MADE ❑OCCUR <br />MEDE%P one non <br />Y <br />Y <br />92-CX-M179.0 <br />02/26/2018 <br />$ 5,000 <br />02/20/2019 <br />PERSONAL A ADV INJURY <br />$ 2,000,000 <br />LIMIT APPLIES PER: <br />POLICY jEeT1:1 <br />GENE AL AGGREGATE <br />f 4,000,000 <br />GENLAOGREGATE <br />PRODUCTS-COMPIOPAGO <br />f 4,000,000 <br />LOC <br />HER: <br />s <br />AUTOMOBILE <br />LIABILITY <br />Y <br />Y <br />4358589-D25-75 <br />10119/2018 <br />10126/2019 <br />' EI uM <br />ANY AUTO <br />scNEouLEn <br />5756448•C08.75 <br />10/19/2015 <br />p9/08/2019 <br />BODILY INJURY Per non <br />_ ( p° ) <br />f ry <br />1,OOD 000 <br />BODILY INJURY(Peraccblen0 <br />$ 1,000.000^� <br />AUTOS <br />AUTOS ONLY AUTOS <br />AUTOS ONLY AUTN SONNY <br />-PE tl GE <br />f 11000,000 <br />3 <br />UMBRELLA UAB <br />OCCUR <br />EACH OCCURRENCE <br />f <br />"CEO$UAL <br />CLAIMS MADE <br />AGGREGATE <br />$� -- <br />CEO TION <br />S <br />WORKERS COMPENSATION <br />Eft T . <br />AND EMPLOYERS'UABILMY YIN <br />T E <br />E1,VACHACCIOENT <br />s 1,000,000 <br />AY OFFRBER EXCLUDED?ECUTVE <br />ICE/MEMa <br />NIA <br />92-EK-T968.4 <br />02/28/2018 <br />02/2812019 <br />E.L. DISEASE-EAEPLOYE <br />S 1,000,000 <br />1Mantla.$%In NN) <br />IIYaa, describe under <br />E.L DISEASE -POLICY LIMIT <br />3 1,000,000 <br />OES RIPTI N 9.FO RATIONS below <br />DESCRIPTION OF OPERATIONS I LOCATIONS /VEHICLES (ACORO tei, Addlllonal Remerks Sebadulo, may ba aaaehed if MoM apace H vquhed) <br />.30 DAY. NOTICE OF CANCELLATION, EXCEPT FOR 10 DAYS FOR NON-PAYMENT OF PREMIUM WILL BE PROVIDED. <br />CEVIEWED BY: EUNICE HEREDIA(PGI,p j <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />ADDITIONAL INSURED: ACCORDANCE WITH THE POLICY PROVISIONS, <br />CITY OF SANTA ANA DEPARTMENT OF PUBLIC WORKS <br />20 CIVIC CENTER PLAZA AUTHORIZED TATNE <br />SANTA ANA, CA 92702 <br />19 15 C RD CORPORATION. All rights reserved. <br />ACORD 26 (2016103) The ACORD name and logo are registered marks f ACORD <br />1001438 132849.12 03:16401e <br />