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VEHICLE OR EQUIPMENT C1 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ON CERTIFICATE ODES NOT AFFIRMATIVELY OR NEGATIVELY AMEN[ BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITI. REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER, This form Is used to report novgraget. provided to a single specloo vehi, provided to multiple vehicles ukWer a single policy. Use ACORD 25 for t PRoouCER INSURED David t Reyes, Agent 2$40 W Lincoln Avenue Anahelm, CA 02601 SQSA, FELIPE 1617 5 SYCAMORE ST SANTA ANA CA 92707-2230 DESCRIPTION OF VEHICLE OR EQUIPMENT YEAR MAKE IMANUFACTURER 2005 ISUZU NPR DESCRIPnoN ;RTIFICATE OF INSURANCE 1ODATE (M W251201AgvDDrYrrv) .Y AND CONFERS NO RIGHTS VpON THE CERTIFICATE HOLDER. THIS EXTEND OR ALTER THE COVERAGE AFFORDED DY THE POLICIES TE A CONTRACT BETWEEN T14E ISISUING INSURER(S), AUTHORIZED le or equipment. Do not use this form to report liability coverage lat purpose. David I Re es IIo a 744 527-f5103 EMAIL ,�jC, I.Vnll 714-527-4WW5 A - daVltl.i.rsye5.48s tate(DmLcarn P Op C6R sraM tNSU 8 AFFDRgINOCOVCRAGR HNC/ INSURER A: Slate Farm Mutual Autotnoblfa Insurance Company 25178 INR�IR a EISiI ERC IN5l1RER D : - I uHrrtt±: MODEL BODY TYPE VEHICLE IDENTIFICATION NUMBER BOX JALE5J18567903323 SERIAL NUMBER THIS I$ TO O[ R f1FY THAT THE POLICY(lE8) QF INSURANCE LISTED Ba4)W RASIHAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY OF ANY TERNI CIAANCE CEAFFORDEO WFICHIT'HIS CERTIFICATE MAYBE BY THEDITION NITWITH � OR OTHER HER ISSUEn R MAY PERTAW. TNY HE INSURpp dy[l ALL THE TERMS. EXCLUSIONS AND S) DESCRIBED IN IWAfjE SVSJEG O CONOI•IIONS OF SUCFI POLICY(WM, INSR ADDY LTR WRD TYPE OP INSURANCE POLICYEPrwnv& POLlCYE%PIRATION POLICY NUMBER DATBrh1Ml♦WYYYY} DATA(MMMOlYYYY) LIMITa 7xj VEHICLE LIABILITY COMSINEDSINGLELIMIT ; 1,000,000 A 538 5534 bt9-7a� OV1912019 1011912DI O BODILY INJURY BODILY INJURY (Poracaidehl) $ PROPER - PROPERTY DAMAGE $ GENERAL LIABILITY OCGURENGE � OCCURRENCE GENERALAGOREGATE $ CLA1M3 WMADE — fN11tt LTR in" 0ANIM TYPE OF INSURANCE S POLICY EFFECTIVE POLICY EXPIRATION POLICY NUMBER DATE11AW IYYYY) DATEIMId1D011M) LIMITS1DEDUCTIBLE ❑ ACV ❑ AGRPDAMT ; LIMIT VEHCOLUSIONLOSS ._. _ ❑ ❑ STATEI)AMT ; DEC ❑ ACV ❑ AOREEDAMT ; LIMIT VEH COMP VEHl71'C „ — d ❑ STATEDAMT $ DED PROPERTY - -----•-�_.--_._� ElAQREEDAMT BASIC BROAD❑ACV ; LIMIT Q Rtt ❑ STATEDAMF —SPECIAL © ; DIED REMARKS (INCLUDINQ Sr'ECIAL COND171tlNS ! OTHER COVERAGES) (Attach AGORD AddltIonal Vim.( lei, Roma, ka schedule, IF morn spoon )s rwlulrod} DEDUCTIBLE: COMP 1000 COLL 1 GOD jt I J ADDITIONAL INTF.FII ST— Select one or uie tonow)ng: The eddltlonal Interest described below hao been added to the polley(les) Ileted heroin by Polley ntsnber(s)• A rerM1 Dal has hasn s¢Ipniaed to add Weaddllkmal Interest doscdbed below to the popoypeo) _ hoeeln pti acNev aural ksr[nf. VEHICLEIEQUIPMENT INTEREST: LEASED FINANCED � - NAME AND ADDRESS OF ADDITIONAL INTEREST CITY OF SANTA ANA RISK MANAGEMENT 20 CIVIC CENTER PLAZA SANTA ANA, CA 92701 ACORD 23 (2010/03) SHOULD ANY OF THE Ala jl`ff6& gBECANCELLED BEFORE THE ExinRAT N Oita►& �IEOr. NOTICE WILL BE DELIVERED IN ACCOROAN L N11 THE POLICY PROVISIONS. DESCRIPTION OF THE ADDITIONAL INTEREST ADDITIONAL INSURED LOESPAYI3B LENDER'S LOSS PAYEE LOAN t LEASE NUMRETir� REPRESENTATIVE The ACORD name and lOgO are realstered marks of ArORn 1004361 142987.2 01-26-2013