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A'CC R ® CERTIFICATE OF LIABILITY INSURANCE UATE (MM1110l1lYVYY1 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 )NSURER(S), AUTHORIZED REPRESENTATIVE OF PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT; If the certificato holder Is an ADDITIONAL INSURED, the pollcy(ies) must have ADDITIONAL INSURED provislons 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 PRODUCED tielN ins t E{IdlO SOUIIfL110e Jl $fatefarm Eddie Ouill�ares Jr, Slate Farm Insurance PHONE '114-611 7150 iV1,G.Ne.EkE1 41SNII Broadway E.MA]L EdcdR@£delleQInsUfanr.ea .lapRCtG9.b �'„ ' Santa Ana, Ca 92701 Slate Farm Fit a and Casua INSURED ADRIANA'YAZv1IN MARTINEZ {N9UR ia.LL- 548 COLS -TON AVE LAPUENTI CAI 1744 _ I{LsfiP _ COVERAGES___ CERTIFICATE NUMBER; 75-0450 _ REVISION NUMBER: THIS IS TO CERTIFY THAT- THE POLICIES OF INSURANCE LISPED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL 'EHE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. W9R --_. ''- EAD�i.l$l1BRT-'-'� --- "- "("POL ICY F, rF POLICYE%P L� TYPE OF INS WANCE �..�iJ l ®®POLICY NUMBER sIMMIRPIYYY,gI IMMIPDIYYYYI LIMITS COMMERCIAL GENERAL LABILITY ( F,ACt{t)i.CURRLNCE g 7 00000D (SAFIAC["Td#En'q'RD CLAIMS AIAOE I� OCCUR I I MfgFs,j_py,Rrprtg{r {j $ 000000 V Loss of Income »_._ ._ JI ,M1]Fn BxP fAnv w,nn Nslw,At 5 5000 ^_ A I I Deductible $500 Y 92-GR-F509-2 101/01/2020 01/0'1/2021 �pERSONAI &ADV INduRv, g 1,001000 .,._.... ............ l m ._. ( GEN L AGG REGAI E L NOT AP PI I ES PER; CENERALAGC RFCATE _ 2000000 _ . PRO j - i — 2 000 000� --- !XPOLICY�Ew. 1IECT I,_,,,,,!LOC ! 1 PRooucI'S.(AMProV AGO $ - ..-w I U7ttER. E $ _ AUTOMOBILE 4ABIWTY -G rT {P 7+41NgLa;LILtiTtf- I , 1 I (Ert neBCw111___ -� ANY AUTO j ("BODILY INJURY (P r yelsor) S O1vNED ��' SC NmULEO AUTOS ONLY AUTOS j BODILY INJURY (Per aCatlenq $ i HIRED NDNO��.Ni nPOPERTY'GA'iNAaE-""'" AUTOS � All TOG ONLY I Pr deL)II,_ _S AIJ70S _ J UMBRELLA LIAR �m I� _ ! OCCUR EACH OCCURRENCE 5 mT EXCESS HAD uAiMS414ADE i AGGREGATE DEO� RE1ENT ONS m� WORKERS COMPENSATIOII # ��N I Ir rt i N AND EMPLOYERS LIABILITY YIN 1 ' 4jjUY AN/IReOPRIETORMARTNE'LEXECU❑/C EHAOGIDENT a OFFICEPIMEMBER EXCLUO"Ut �L EAC I RN IA i - __ _ __. _.. #(Mandatory In NYD I EL 6E<FAHE SEA fMF`LQ'tG.E<-.a IZs, descdbe wide, T FAPTION OF OPERA10INS Woow -'-mil 1 w ( ES. DISEASE POIJOY LIMIT 1 S DESCRIPTION OF OPERATIONS ILOGAIIONS I VEHICLES (ACORD Lot, Additional Rumarks Schedule. may be attached it mare a pace Is rsNulmd)REVIEWED eX A`�!-IBOYE&.0 The City of S INSURED: 6y RiSk MANA('fEMENT DIVISI(9N The City Of Santa Ana, 20 Civic Center Plaza, Santa Ana, California 92701; its officers, employees. agents and volunteers arenamxl as additional Insureds W12: Certificate of Insurance shall provide Ihirty (30) clay prim written police of cancellation FRANINLAREA SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN THE CITY OF SANTA ANA ACCORDANCE WITH THE POLICY PROVISIONS. RISK MANAGEMENT DIVISION 20 CIVIC CENTER PLAZA, 4TI-I FL aurHGaizeo REPRESENTATIVE SANTA ANA CA 92702 { 01fiT9 2015 A.. 40444..C��XO.RMP O�RA710N. All rfphts reserved ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD I001,196 13211n012 e;l 16.1016