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Al, Z)I?-Z3-7 <br />-C:� CERTIFICATE OF LIABILITY INSURANCE I DAYSSINUDONYM <br />11/07/2019 <br />ATION ONLY AND CONFERS NO RIGHTS THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORM <br />TS UPON THE, CERTIFICATE HOLDER THIS <br />CERTIFICATE DOES NOT AFFIRAI'ATIVELY 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 eortifkato holdor Is an ADDITIONAL INSURED, the policy(le4) must be endorsed. It SUBROGATION IS WAIVED, subject to <br />the terms and conditions of the policy, certain policies may require an endorselnerR A statement on this certificate does not confer rights to the <br />eortificato holder In lieu of such andorsement(s). <br />PRODUCER I w,ke SCOTT CAMPOS <br />Scott Campos InsU nce Agency, Inc PN NE 714-777-0200 .714777-0215 <br />State Farm 4945 Yorba Ranch oad Suite D AD E .bC i IQPSCOTTCAMPOS.COM <br />0 0, <br />YOIbBLindaCA92 87 1 WSUR61l(5)AFFORDINGCOVERAGE <br />1508 E <br />THIS IS TO CERTIFY THAT THE POLICIES <br />INDICATED. NOTWITHSTANDING ANY <br />CERTIFICATE MAY BE ISSUED OR MAY <br />EXCLUSIONS AND CONDITIONS OF SUCH <br />REVISION NUMBER: <br />OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD <br />iiEQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br />PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br />POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />TYPE OF wSURANCElug <br />Y <br />Jw <br />POYCYNUMRPR <br />EFF <br />��� <br />MM O <br />UNITS <br />A; <br />X <br />CONYERCIA 1-LLLWBBAty <br />rrLAPASMADE DE ❑OCCUR <br />92-GS-Z131-7 <br />10/3012019 <br />1013012020 <br />EACHOCcuRRENcE <br />s 1.000.000 <br />PREMISESna <br />S 300.000 <br />f 6.000 <br />,r r: <br />MEOEXPW pre anm <br />PERSONAL B ADV INJURY <br />a <br />II <br />OEM <br />AGGREGATE LIMIEl T APPLIES PER: <br />OTHEY i�.J�-' <br />GENEAGGREGATE <br />S a,000,000 <br />PRODUCTS-COWIOPAGG <br />S Z000.000 <br />5 <br />A <br />' 1 <br />AOTHLUeIIm <br />X <br />X <br />ANYA <br />AAIIITDOSN. D SC.EDUUD <br />HREDAUTOS X NON " <br />AUTOS" <br />� <br />5-E6-75 <br />VI2017 DODGE CHARGER <br />N: 2C3CDXBG8HH612379 <br />O5H6R019 <br />11/1612019EaC <br />L <br />5 1,000.000 <br />SCOILYINJmrURY(Perp) <br />S <br />BODILY INJURY tP..wcMI) <br />9 <br />P�eOsmllm ..AGE <br />S <br />LA <br />OCCUR <br />COLUCOMP DEDUCT <br />s 500 <br />A <br />EXCESS XCESS L1AB E; <br />E <br />ITN/A; <br />�'QSZ�'0 <br />- <br />1013012079 <br />10t30/2020 <br />EACH OCCURRENCE <br />E <br />AGGREGATE <br />S <br />OEO RErENTiONS <br />WORKERS COMPENSATION <br />ANOWPLOY S•LIABIUtt <br />ANTPROPNIETORRARTNEWEXECunVE Y/N Ivim <br />OFFICERlAIEMBER EXCLUDED? I <br />(Manaelory In NN) V <br />It e, CesUta under <br />a1PnoN OP OPERAnp18 Dale. <br />1.r <br />1 <br />X ST 1 <br />E <br />EL EACHACCIDEM <br />S 1,DOO.OSo <br />EL DISEASE -� <br />EA EMPLOYE <br />3 1,000,000 <br />EL DISEASE-POUCYUNIT <br />3 1,000.000 <br />DESCRIPTIONOFOPERATONSILOCpTNwel <br />ADDITIONAL INSURED ON GENERAL. LIABILITY: <br />CITY OF SANTA ANA, ITS OFFICERS, <br />pIDGROT0I, AUGIIIOMI Ramerlu SnReUPIe,R,eY d.:tlacNVJ amen epees l0 mp,d,vll <br />MPLOYEES, AGENTS, VOLUNTEERS AND REPRESENTATIVES <br />'-Such Insurance BE IS afforded by this <br />Icy shall be primary, and any Insurance carried by City shag be excess and noncontributory•• <br />CER71FIre TF unI nce <br />---' NOGCLL ILVN <br />City of Santa"Ana I <br />Risk Management Divislon YRik •NACEMENTDIVISI N SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />20 Civic Center Plaza, 4th l00 2�19 ACCORDANCE WITH THE POLICY PROVISIONS, <br />Santa Ana, CA 92701 A <br />M. <br />e- -av Pr^w uWEV I IUN. All rights reserved. <br />ACORD 25 (201g101) ACORD name and logo are registered! marks of ACORID f OD1488 132849.9 02-04.2014 <br />..rd ill..,.:..,... <br />ill <br />