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Francine R. a9yn9�mra,�a <br />Villareal <br />AIlls CORO® 1111 CERTIFICATE OF LIABILITY INSURANCE <br />Do5i20/2020 Y) <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(ies) 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 Sariah Devereaux-Barrientos, Agent <br />1417 S Broadway <br />StateFarm Santa Ana, CA 92707 <br />CONTACT <br />NAME: SARIAH DEVEREAUX-BARRIENTOS <br />PHOE <br />AICNNo Ext:714-541-7280 aIc No:714-384-3892 <br />E-MAIL <br />ADDRESS: sariah.devereaux.t8lb statefarm.com <br />INSURER(S) AFFORDING COVERAGE <br />NAIC9 <br />INSURERA: State Farm Fire and Casualty Company <br />25143 <br />INSURED Mente Inc <br /> <br /> <br />INSURER B: <br />INSURER C: <br />INSURER D: <br />INSURER E <br />INSURER F <br />COVERAGES CERTIFICATE NUMBER: 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 MAYHAVE BEEN REDUCED BY PAID CLAIMS. <br />INSR <br />TR <br />OF INSURANCE <br />ADDLSUBRTYPE <br />INSR <br />WVD <br />POLICVNUMBER <br />MMIDDY POLICY EFF <br />VVV <br />POLICY EXP <br />Y MMIDDVVV <br />LIMITS <br />A <br />GENERAL LIABILITY <br />92-EK-V825-4 <br />05/20/2020 <br />05/16/2021 <br />EACH OCCURRENCE <br />$ 1,000,000 <br />PRId 11 <br />EMISES Ea occ rrence <br />$ 300,000 <br />x COMMERCIAL GENERAL LIABILITY <br />CLAIMS -MADE 1K OCCUR <br />MED EXP(Any one person) <br />$ 5,000 <br />PERSONAL & ADS INJURY <br />$ 1,000,000 <br />GENERAL AGGREGATE <br />$ 2,000,000 <br />GEN'L AGGREGATE LIMIT APPLIES PER <br />PRODUCTS - COMP/OPAGO <br />$ 2,000,000 <br />X POLICYPRO- LOC <br />ECT <br />Business Property <br />$ 11,400 <br />AUTOMOBILE LIABILITY <br />COMBINED SINGLE LIMIT <br />Ea NEDt <br />$ <br />BODILY INJURY (Per person) <br />$ <br />ANY AUTO <br />ALL OMSCHEDULED <br />AUTOS AUTOSNONT <br />BODILY INJURY (Per accident) <br />$ <br />HIRED AUTOS AUTOS QED <br />PeOrawideU PERTY DAMAGE <br />$ <br />UMBRELLA LIAB <br />OCCUR <br />EACH OCCURRENCE <br />$ <br />AGGREGATE <br />$ <br />EXCESS LIAB <br />CLAIMS -MADE <br />DED RETENTION $ <br />1 $ <br />WORKERS COMPENSATION <br />WC STATU- OTH- <br />ANDEMPLOVERS'LIABILITY YIN <br />ANY PROPRIETOR/PARTNER/EXECUTIVE <br />TORVLIMITS ER <br />E L. EACH ACCIDENT <br />$ <br />OFFICE/MEMBER EXCLUDED? <br />NIA <br />EL. DISEASE -EA EMPLOYEE <br />$ <br />(Mandatory in NH) <br />EL. DISEASE -POLICY LIMIT <br />1 $ <br />If yes, describe under <br />DEDUCTIBLE $2000 <br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) <br />City of Santa Ana, officers, agents, employees, and volunteers are named as additionally insured on this policy pursuant to written contract, agreement, or <br />memorandum of understanding. Such insurance as is afforded by this policy shall be primary, and any insurance carried by City shall be excess <br />30 Days Notice of Cancellation with 10 Days Notice for Non -Payment of Premium in accordance with the policy provisions. <br />CERTIFICATE HOLDER CANCELLATION <br />City of Santa Ana <br />Risk Management Division <br />20 Civic Center Plaza <br />Santa Ana, CA 92702 <br />ACORD 25 (2010/05) <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 />AUTHORIZED REPRESENTATIVE <br />© 1988-2010 ACORD CI <br />The ACORD name and logo are registered marks of ACORD <br />Risk Manage numd Division <br />REVIEWED I APPROVED BY.' <br />®' <br />® Risk Management Analyst <br />