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`` Dr CERTIFICATE OF LIABILITY INSURANCE
<br />ATE
<br />o06/28/2018Y1
<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 QUIllare8 Jr.
<br />NAME:CONTACT Eddie QUI ares
<br />State Farm Agency
<br />,�, 1,„ 415 N. Broadway
<br />HONE
<br />TAJO-Ne,rxtI.714.617715U_ iac rlo) 714617.7158
<br />EMAIL -_
<br />ADDRESS: eddle@eddleglnsurance.com _.._
<br />JSanta Ana, CA 92701NSURER
<br />5 AFFORDING COVERAGE NAICk
<br />INSURERA: State Farm General Insurance Company
<br />2515
<br />rY
<br />INSURED DOWNTOWN INC
<br />INSURER B: State Farm Fire and Casualty Com an
<br />25143
<br />INSURER0._..__
<br />1,000,000Y
<br />200 N MAIN ST FL 2
<br />INSURER D:
<br />SANTA ANA CA 92701
<br />INSURER E,
<br />INSURER F:
<br />300,000
<br />MED ESP (Any one person) $
<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 />(ICY
<br />LTR
<br />TYPE OF INSURANCE
<br />INSR
<br />Me R
<br />POLICY NUMBER
<br />MM DDPOLICNYYY
<br />EXP
<br />MMLDDIYYYV
<br />LIMITS
<br />A
<br />GEERAL LIABILITY
<br />rY
<br />92•CE-933-0
<br />O6/05I2018
<br />O6I05/2019
<br />EACH OCCURRENCE $
<br />1,000,000Y
<br />X COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE Z OCCUR
<br />GETO ftENTEU____ _.
<br />PREMISES Ea occurrence $
<br />300,000
<br />MED ESP (Any one person) $
<br />5,000
<br />PERSONAL &ADV INJURY $
<br />1,000,000
<br />.._.,.. .__ ._..._._
<br />GENERAL AGGREGATE It
<br />2,000,000
<br />PRODUCTS - COMP/OP AGG $
<br />2,000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />POLICY PR' LOC
<br />$
<br />A
<br />AU
<br />AUTOMOBILE
<br />.__
<br />LIABILITY
<br />Y
<br />❑'
<br />75-0450•X94
<br />06!2812018
<br />12/28/2018
<br />COMBINED SINGLE LIMIT
<br />Eaaccident $
<br />1
<br />ANY AUTO
<br />ALL OWNED I yI SCHEDULED
<br />AUTOS �I AUTOS
<br />li HIRED AUTOS NON -OWNED
<br />AUTOS
<br />BODILY INJURY (Per person) $
<br />250,000
<br />BODILY INJURY (Per acciden0 $
<br />500,000
<br />_
<br />PROPERTVDAMAGi
<br />Per accident $
<br />--
<br />100,000
<br />ComplColl Ded $
<br />250
<br />A
<br />X
<br />UMBRELLA LIAR -X
<br />OCCUR
<br />Y
<br />92•CE-Q781-7
<br />06/0512018
<br />06105/2019
<br />EACH OCCURRENCE $
<br />1,000,000
<br />AGGREGATE $
<br />2,000,000
<br />EXCESSU a._
<br />(CLAIMS -MADE
<br />DED X RETENNON $ 10,000
<br />$
<br />B
<br />WORKERS N
<br />AND EMPLO ERSELIABILODY YIN
<br />ANY PRO PRIETOR, PARTNER; EXEC U TIVE
<br />OFFICUMEMBER EXCLUDED? Y
<br />(Mandatory In NH)
<br />If yes, descdbe under
<br />NIA
<br />92 -LH -2053-2
<br />06/05/2018
<br />06105/2019
<br />7—WC-S—TAT
<br />1 TORYLMITs X (GER
<br />1,000,000
<br />E.L. EACH ACCIDENT $
<br />1,000,000
<br />EL DISEASE -EA EMPL�DYEI $
<br />1,000,000
<br />E.L. DISEASE -POLICY LIMIT $
<br />1,000,000
<br />F OPERATIONS hal..
<br />A
<br />FIOELTY BOND
<br />1-10
<br />92 -WV -6044-5
<br />10/03/2017
<br />10/03/2018
<br />BOND -AMOUNT $
<br />500,000
<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 />\i
<br />04
<br />CERTIFICATE HOLDER CANCELLATION
<br />CITY OF SANTA ANA
<br />20 CIVIC CENTER PLAZA 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 />ATTENTION RISK MANAGEMENT
<br />AUTHORIZED REPRESENTATIVE/%/
<br />6V Y o
<br />BRIZA MORALES
<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 />
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