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parr® CERTIFICATE OF LIABILITY INSURANCE DArE,AIA°DIYYY <br />pen5nnte <br />S CERTIFICATE IS ISSUED ASA MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER, THIS <br />RTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED RY THE POLICIES <br />F <br />OW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTEA CONTRACT BETWEEN THE ISSUING INSURER)S), AUTHORIZED <br />RESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. <br />IMPORTANT: If the cortllicato holder Is an ADDITIONAL INSURED, the policy(fes) must have ADDITIONAL INSURED provisions or be endorsed. <br />If SUBROGATION IS WAIVED, sub)ect to the terms and conditions of the policy, certain policies may require an endorsement. A statement on <br />this certificate does not confer rights to the certificate holder In lieu of such endorsermant)3). <br />PRODUCER <br />NNMaA DlAnna Merin <br />Insurance Agency <br />PCNa ear; (9181 T84.9070 NXx (918)7840158 <br />C No: <br />50$ Vernon Street <br />li <br />AppNE69: diannaQAli —Irence,wre <br />INSUgaR9AFFOROINO COVERAGE <br />NAICP <br />Re <br />INSURERA: mur Insurance Alliance of California <br />NwgINSURFRB: <br />0111145 <br />CA 95678 <br />INSSUREDURED <br />Slate Compensation insurance Fund <br />$5078 <br />The Lq3 Angeles Dream Sh0pCr3 <br />INSURER C: <br />P.O. Box3831 <br />INSURER D s <br />INSURER 9 <br />Orange CA 92885 <br />INSURERF <br />enveo Anre .. .,, ......,....... <br />c: <br />THIS IS 70 CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED <br />ABOVEFOR HE POLICY <br />ABOVE FOR THE POLICY PERIOD <br />INDICATED NOTWITHSTANOINO ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHERDOCUMENT WITH RESPECT TO WHICH <br />THIS <br />CERTIFICATE MAYBE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN M SUBJECT <br />TO ALL THE TERMS, <br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />wa AD <br />TR TYPE OF INSURANCC IN80 POLICYNUMBER L <br />SIM/0 AIEUDO LIMITS <br />x , <br />COMMCRCIALGENERALUABIUN <br />EACHbC.CURgCNCE <br />S 1,000,000 <br />PR TI r3 (Eaaxurmrcel- <br />6 500,000 <br />CLAIMS -MACE �CCCUR <br />Liquorliabllily <br />x, <br />MEOExP(nn pne arson <br />S 20,000 <br />A <br />Y <br />2018-08609NP0 <br />00/13/2018 <br />03/13/2010 <br />$1,000,000M.Cog000 <br />PEA6OIaAl1 AAYINJURY <br />3 11000,0 00 <br />LIMIT APPLIES PER <br />GENERALAOMEOAIE <br />S 2.000.00(1 <br />bEMLAGGREOATE <br />PRODNCTS•COMPIOPAGG <br />S 2.000.000 <br />POLICY ❑ JET ® LCC <br />Mr. <br />S <br />AUTOMOBILE <br />LIADILIN <br />Ea aaNgos UMIANY <br />S 1,OOQp00 <br />eOmLY INlURY(Par parsanl <br />S <br />A <br />OWNeOTO <br />SCHEDULED <br />8001LYMJURI'(Per.Wdano <br />3 <br />AUTDS ONLY AurOs <br />AWVOS Auros, <br />2UI8.08609NPO <br />0611342018 <br />03/132019 <br />HIRED NON OWNED <br />x <br />P rauitlentArA <br />6 <br />AIJTG9 ONLY AUTOS WILY <br />CompICOII deductible <br />6 50D <br />MBRELIALIA8 <br />OCCUR <br />;EXCES3LIAO <br />EACHOCCURRENCE - <br />3 <br />_ <br />S <br />CLAIIAC-MADEAOOREGAFE <br />en REFENTION 9 <br />5 <br />WORRE SCOST NOAIION <br />AND EMPLOYERS' UAWLITY YIN <br />--" <br />x TA�L <br />B <br />ANY PROPRIEV)PIPARTNERlEXECUTIVE <br />OFFICER/MEMBER exGLdDED? ❑ <br />N/A <br />9015327-98 <br />08/0$/2078 <br />06108/2019 <br />E.t. FACH Af,GiDENT <br />S 1,000,000 <br />(Mandatorvin NH) <br />11yyaa. tlaem"under <br />EL.CISWE•EAEMgLOYE1 <br />S 1,000,000 <br />OESCRIPfW lM'PERADONS W. <br />E 6. DISEASE, POLICY LIMIT <br />4 11000.000 <br />OESCgIPiION OF OPERATIONS/LOCAtI0N61 VEHICLE6 IAGGRO tot, 0.ddiHanal R+mmksaebedula, may ba a a,mbetlammAeF+c+1. nquhetll <br />�`T <br />The City of Santa Ana, its officers, agents, employees and volunteers are named additional insured under their contract terms. Coverage Is0Bifr 8nd <br />nonconldbutory and Form CD 20 28 applies -y1\ <br />SHOULD ANY OF THEASOVE ESCRIBEfTyg51 ESEECANCELLEDBEFORE <br />THE EXPIRATION DATE THEREOF, NOTICPP WILL BE DELIVERED IN <br />City of SenlaAna ACCORDANCE WITH THE POLICY PROVISIONS. <br />20 Civic Center plaza <br />AUTHORRED REPRESENTAOVE <br />Santa Ana <br />ca 92701 <br />m 1988-2015 ACORD CO PORATION. Aff7ights reserved, <br />—^•- r ••••.v, ern Aa vnu name anu logo are registered marine of ACORD <br />