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"III " CERTIFICATE OF LIABILITY INSURANCE
<br />D01 /2019 )
<br />0
<br />01/07/2019
<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(ies) 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 QUIIIares Jr.
<br />NAMEACT Eddie QUlllares
<br />State Farm Agency
<br />415 N. Broadway
<br />Santa Ana, CA 92701
<br />PHON o 714.617.7150, FAX No:714.617.7158
<br />E-MAIL
<br />ADDREss: eddie eddie insurance.com LAIC,
<br />NSURER S AFFORDING COVERAGE
<br />NAIL#
<br />INSURER A; State Farm General Insurance Company
<br />INSURER B: Slate Farm Fire and Casualty Company
<br />25151
<br />25143
<br />INSURED DOWNTOWN INC
<br />204 E 4TH STREET STE T
<br />INSURER C:
<br />INSURER D:
<br />SANTA ANA CA 92701
<br />INSURER E
<br />INSURER F:
<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 />ILTR
<br />TYPE OF INSURANCE
<br />ADDL
<br />INS
<br />SUER
<br />POLICY NUMBER
<br />POLICY EFF
<br />MMIDD/YYYY
<br />POLICY EXP
<br />MMIDDIYYYY
<br />LIMITS
<br />A
<br />GENERAL LIABILITY
<br />X COMMERCIAL GENERAL LIABILITY
<br />717
<br />FYI
<br />FYI
<br />92-CE-Q933-0
<br />06/05/2018
<br />06/0512019
<br />EACHOCCURRENCE
<br />$ 1,000,00E
<br />DA A ETO REN ED
<br />PREMISES Ea occurrence
<br />$ 300,000
<br />MED ESP (Any one person)
<br />$ 5,000
<br />CLAIMS -MADE OCCUR
<br />PERSONAL &ADV INJURY
<br />$ 1,000,000
<br />_
<br />GENERAL AGGREGATE
<br />$ 2,000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />POLICY J T PRO-
<br />LOG
<br />PRODUCTS - COMP/OP AGO
<br />$ 2,000,00E
<br />$
<br />A
<br />AUTOMOBILE
<br />LIABILITY
<br />E
<br />6215237+28.75
<br />12/28/2018
<br />06128/2019
<br />EeaBINEDtsINGLELIMIT
<br />$
<br />X
<br />ANY AUTO
<br />ALL OWNED X SCHEDULED
<br />AUTOS AUTOS
<br />HIRED AUTOS X NON -OWNED
<br />AUTOS
<br />BODILY INJURY (Par person)
<br />$ 1,000,00E
<br />BODILY INJURY (Per accident)
<br />$ 11000,000
<br />PROPERTYDAMAGE
<br />Per accident
<br />$ 1,000,00E
<br />$
<br />A
<br />B
<br />)(
<br />UMBRELLA LIAB
<br />EXCESS LIAB
<br />X
<br />OCCUR
<br />CLAIMS -MADE
<br />Y
<br />N I A
<br />❑Y
<br />92-CE-Q781.7
<br />92-CE-R552.3
<br />06/05/2018
<br />06105/2018
<br />06/0512019
<br />06/0512019
<br />EACH OCCURRENCE
<br />$ 1=0,000
<br />AGGREGATE
<br />$ 2,000,00E
<br />DED X RETENTION$ 10,000
<br />WORKERS COMPENSATION
<br />ANDEMPLOYERS'LIABILITY YIN
<br />ANY PROP R IETOMPARTN ER'EXEC UTIVE
<br />OFFICE/MEMBER EXC TDED9 Y❑
<br />WC STATU- OTH-
<br />BY LIMIT X T
<br />$
<br />1,000,00E
<br />EL EACH ACCIDENT
<br />1,000,00E
<br />EL.DISEASE - EA EMPLOYE
<br />$ 11000,000
<br />If y., dtoryin NH)
<br />f yes, tlescrlbe antler
<br />E.L. DISEASE - POLICY LIMIT $ 1,000,000
<br />BOND -AMOUNT $ 500,00E
<br />A
<br />FIDELITYBOND
<br />TIE]
<br />92-WV-60445-F
<br />10/03/2018
<br />10/0312019
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is required)
<br />City of Santa Ana its officers, agents, employees and volunteers are named as additional insured.
<br />Additional Insured endorsement issued for certificate holder with Wavier of Subrogation and non-contributory
<br />ry'
<br />l—
<br />e
<br />CITY OF SANTA ANA
<br />20 CIVIC CENTER PLAZA SANTA ANA, CA 92702
<br />ATTENTION RISK MANAGEMENT
<br />BRIZA MORALES
<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 />©1988.2010 ACORD CORPORATION All
<br />ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD 1001486 132849.7 03-01-2012
<br />
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