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ACCDIRE® CERTIFICATE OF LIABILITY INSURANCE <br />ATE (MMIDDNY" <br />D05111/2018 <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 the <br />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 Eddie QUIIIare$ Jr. <br />State Farm AgencyN-2019-014 <br />415 N. Broadway <br />.a, Santa Ana, CA 92701 <br />CONTACT <br />NAME: Eddie QUillares <br />PHONN t: 714.617.7150. a Na: 714.617.7158 <br />E-MAIL <br />ADDRESS. eddie@eddieginsurance.com <br />INSURERS AFFORDING COVERAGE <br />NAICK <br />INSURERA: Stale Farm General Insurance Company <br />15151 <br />INSURED Yenny Bernal DBA Uplifting Soul Art Events <br />1052 W Pine St <br />Santa Ana, CA, 92703 <br />INSURER B: <br />Nv'Q <br />�a <br />INSURER C: <br />92=EX K572.8 <br />INSURER D: <br />05106/2019 <br />INSURER E: <br />INSURERF: <br />COVERAGES CERTIFICATE NUMBER: 75-0450 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 />INSR <br />LTR <br />rypE OF <br />ADDL <br />SUBR <br />POLICY NUMBER <br />POLICYEFF <br />MMmDII'9YY <br />POLICY EXP <br />MMIDDNYM <br />I LIMITS <br />A <br />BENERALLIABILIry <br />Nv'Q <br />�a <br />92=EX K572.8 <br />05/06/2018 <br />05106/2019 <br />FACHOCCORRENOE S 1,000,000 <br />COMMERCIAL GENERAL LIABILITY <br />CLAIMS -MADE FxIOOCUR <br />PREMSES Ea occurrence) 5 300,000 <br />MED EXP( Anyone person) S 5,000 <br />PERSONAL S ADV INJURY S 1,000,000 <br />GENERALAGGREGATE s 2,000,000 <br />GEN'LAGGREGATE <br />LIMIT APPLIES PER: <br />PRODUCTS AGG S 2.000,000 <br />POLICY <br />PEP LOC <br />5 <br />AUTOMOBILE <br />LIABILITY <br />❑ <br />❑ <br />COMBINED SINGLE LIMIT <br />Ea accident s <br />BODILY INJURY (Per parson) S <br />ANYAUTO <br />ALLOWNED SCHEDULED <br />AUTOS AUTOS <br />BODILY INJURY (Per <br />( S <br />NON -OWNED <br />HIRED AUTOS AUTOS <br />PROPERTY DAMAGE <br />m <br />PeraccdeS <br />s <br />UMBRELLA UAB <br />OCCUR❑❑ <br />EACH OCCURRENCE S <br />AGGREGATE 5 <br />EXCESS UAB <br />CLAIMS -MADE <br />DED RETENTIONS 10,000 <br />S <br />WORKERS COMPENSATION <br />WC STATU- OTH- <br />AND EMPLOYERS'UABILITY Yll <br />ANY PROPRIETORIPARTNERIEXECUTIVE <br />OFFICEIMEMBER EXCLUDED? D <br />NIA <br />❑I <br />TSR <br />E.L.EACH ACCIDENT 5 <br />E.L. DISEASE -E4 EMPLOYE S <br />(Mandatory In NH) <br />If yes. describe under <br />DESCRIPTION OF OPERATIONS brb� <br />E. L. DISEASE -POLICY LIMIT S <br />$ <br />DESCRIPTION OF OPERATIONS I LOCATIONS /VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) <br />Circa De Mayo Celebration in Downtown Santa Ana. Uplifting Soul Art Event will beat the Yost Plaza/Spurgeon Promenade. <br />1 l.'hli%A"!T'-"5+-40' <br />T E-CIT1 Y�OF�SANTA /f,IT1S;OF$F7CERS3 Iv PLQY.EE .�.A EfiGI'S';AND REPRESENTATNEAP�FI "I;DTIAS;ADDjTIONP.LsINSUREC-"IN REGARDS TO <br />G N_E�LrIABILI_TVIPERATiACNEDXMIBIT BADDITIONAL INSURED FORM.—�--x"k:. <br />CITY OF SANTA ANA <br />20 CIVIC CENTER PLAZA <br />SANTA ANA, CA 92701 <br />SONIA BATRES <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 />©1988-2010 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD 1001486 132849.7 03-01-2012 <br />clkinip,b UO -M , P li"Z <br />