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ACC: bF VEHICLE OR EQUIPMENT CERTIFICATE OF INSURANCE <br />DATE(MWDD"YM <br />02113/2019 <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 />This form Is used to report coverages provided to a single Specific vehicle or equipment. Do not use this form to report liability coverage <br />provided to multiple vehicles under a single policy. Use ACORD 25 for that purpose. <br />PRODUCER <br />StateFarm Sarieh Devereaux-BamentosH(AI <br />A. State Farm Agent <br />1202 W let StOF3324 <br />° °T Sarlah Devereaux <br />, EMI: 714-541-7280 .714384-3892 <br />L <br />o sar45417280.co <br />PR OF33249 <br />Santa Ana CA 92703 <br />INSURER ($) AFFORDING COVERAGE NAIC E <br />wsuafiq <br />NSU E . State Farm Mutual Automobile Insurance Company 25178 <br />Roberto Zoveia Cardenas & Crlatine Zavala Reyes <br />DBA Galaxy Party Rentals <br />I Su RB: <br />wsURE R p__ <br />14132 Kerry St <br />GARDEN GROVE CA 92844 <br />_ <br />I SURER D <br />INSURER E: <br />YEAR MAKE I MANUFACTURER MODfit <br />BDDV TYPE <br />VEHICLE IDENTIFICATION NUMBER <br />1994 GMC 3500 <br />Box Truck <br />1GDKC34N9RJ519011 <br />DESCRIPTION <br />VEHICLEIEQUIPMENTVALUE <br />EERIALNUMBER <br />X VEHICLE UA8ILIIY <br />UUVENA1JI=N CFRTIFICATE NIIMRFR! REV!S!0H m9meCD. <br />THIS IS TO CERTIFY THAT THE POLICY(IES) OF INSURANCE LISTED BELOW HA$1HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY <br />PERIOD($) INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO <br />WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICY(IES) DESCRIBED HEREIN ISIARE SUBJECT TO <br />ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICY(IES). <br />Mom <br />LTR <br />INaRo <br />j% <br />TYPE OF INSURANCE <br />POLICY NUMBER <br />POLICYEFFECTIVE <br />DATE(MWDDIYyY'n <br />POU"UPIRATION <br />DATE(MWDDIYYYY) <br />LIMITS <br />X VEHICLE UA8ILIIY <br />COMBINED SINGLE LIMIT S 1,000,000 <br />BODILY INJURY (Per parer) S <br />A <br />1957791-F12.75B <br />02113/2019 <br />12112/2019 <br />BODILY INJURY (Per ■curtent) $ <br />PROPERTYDAMAGE S <br />GENERAL LIAsiLrrY <br />EACH OPOURENCE $ <br />OCCURRENCE <br />GENERAL AGGREGATE S <br />CLAIMS MADE <br />Med Pay S 5,000 <br />ILIMNSR <br />LTR <br />LOb <br />AYr <br />TYPE OF INSURANCE <br />POLICY NUMBER <br />POUCYEFFECTNE <br />DATE (aMR1D1YYYYi <br />POLJICY DATEMXPVMTION <br />DATE (YWDD/riYY) <br />LIMITS IDEDUCTIBLE <br />VEH COLLISION LOSS <br />(]. ACV ❑AGREED AMT <br />$ UMIT <br />11[3 STATEDAMT <br />6 DED <br />VEHCOMP VEH OTC <br />I] ACV ❑ AQREEOAMT <br />Y LIMIT <br />❑ ❑ STATED ANT <br />S DED <br />EQUIPMENT <br />BASIC BROAD <br />SPECIAL <br />❑ ACV ❑ AGREED AMT <br />® RC 13 STATED AMT <br />❑ <br />i UMIT <br />S DED <br />REMARKS (INCLUDWGSPECW. CONDITIONS I OTHER COVERAGES) (AftaO AGORD 101, AddIUOMI Ranladre ECMdurs, )f Mals split M required) <br />Comprehensive deductible: 100; Collision deductible: 500; Uninsured motorist protection: 250,0001500,000 a\I'�•y <br />aolapt orn or tho rollooring: <br />TMaddY i InWatditaibedbatty Hes been added to Supolry(he)IIetW heHen by PdkynMloer(s). <br />A t)1m DeeDaub ID, add MS eddilbnel MHV*) deMdbad beb lO the PoIcy(ias <br />VMICLEIEQUIPMtwrwfmw.. I (LEASED I IFDUNCE) <br />NAME AND ADORES, OF ADDITIONAL W M93T F� <br />CITY OF SANTA ANA <br />20 CIVIC CENTER PLAZA <br />SANTA ANA <br />CA 92701 <br />N — <br />SHOULD ANY OF THE ABOVE <br />BEFORE THE EXPIRATION OA <br />DELIVERED IN ACCORDANCE <br />ADWTK)NALINSURED <br />LENDER'S LOSS PAYER <br />N/LEASENUMBER <br />ACORD 23 (2010/03) The ACORD name and logo ars registered marks of ACORD 'Y <br />looeas) uaMts m-ae•aole <br />