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7 ® DATE (MMIDD/YYYY) '�� — CERTIFICATE OF LIABILITY INSURANCE 8/20/2019 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER, THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the pulicy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). CONTACT PRODUCER NAME: Paul Romero PHOC ROMERO INSURANCE AGENCY W, NO. o ExI: 805-582-4C,55 A)C, INC) IUN 1 197 E. LOS ANGELES AVE. UNIT C199 ADDRESS: romaroins(aaol.com INSURER(S) AFFORDING COVERAGE NAIC p SIMI VALLEY CA 93065 INSURER A: SCOTTSDALE INSURANCE CO. INSURED INSURER B : CALIFORNIA AUTOMOBILE INS. CO MAJOR LEAGUE INFIELDS INC INSURER C : ICW GROUP 508 E. CHAPMAN AVE INSURER D : INSURER E: FULLERTON CA 92832-2015 INSURERF: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THATTHE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. R TYPE OF INSURANCE INSO WVd POLICY NUMBER MMIOOIYYYY MMIDDIYYYY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS -MADE FxI OCCUR PREMISES IEa uu:errgnco $ A GEN'L AGGREGATE LIMIT APPLIES PER: 1-1PRO- POLICY JECT OTHER: AUTOMOBILE LIABILITY x ANY AUTO B OWNEDTOSCHEDULED AUS ONLY AUTOS HIRED Px NON -OWNED tC AUTOS ONLY AUTOS ONLY UMBRELLA LIAB OCCUR EXCESS LIAB CLAIMS -MADE RETENTION $ Y I Y I CPS3179689 Y I I BA040000025174 AND EMPLOYERS' LIABILITY YIN NY P110PRIETORIPARTNERIERECUTIVE ❑ NIA Y W SA504570200 C 0FFFICFRIMEMBER EXCLUDED? JMnlidatory in NH) II yes. describe under 171. 'RIPTIONOFOPERATIONSbelow 07/l/19 07/01/20 MED EXP (Any one porson) $ PERSONAL &ADV INJURY $ GENERAL AGGREGATE $ PRODUCTS - COMP/OPAGG $ $ 12/22/2018 12/22/2019 F� occrdenl $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ (Pararcldono $ EACH OCCURRENCE $ AGGREGATE Is $ 01/01/19 01/01/20 E.L. EACH ACCIDENT is E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ 2,000,000 100,000 5,000 2,000,000 3,000,000 3,000,000 1000000 1,000,000 1,000,000 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) CERTIFICATE HOLDER IS NAMED AS ADDITIONAL INSURED AS RESPECTS TO THE OPERATIONS OF TI F, NAMED INSURL'D. WITH RESPECT TO CLAIMS ARISING OUT OF THE OPERATIONS PrRFORMED BY OR ON BFHALF OF THE: NAMED INSURED, SUCH 1NSURANCI, AS 1S APFORUED' A THIS POLICY IS PRIMARY AND NOT ADDITIONAL TO OR CONTRIBUTING WITH ANY OTHER INSURANCE CARRIED BY OR FORTH[; BENEFIT OF THE; DDI"I'IONAL INSURED. 10 DAY NOTICE FOR NON PAYMENT OF PREMIUM, 30 DAY PRIOR WRITTEN NOTICE OF CANCELLATION REVIEWED & APPROVE L By Risk MANAGEMENT DIVISI( N CERTIFICATE HOLDER CITY OF SANTA ANA RISK MANAGEMENT DIVISION 20 CIVIC CENTER PLAZA, 4TH FLOOR SANTA ANA, CA 92702 ELLATION SHOULD ANY OF THE ABOVE DESCRIBED THE EXPIRATION DATE THEREOF, NOTICE VAU ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD