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TIMEV-1 OP ID: MM <br />A� R" CERTIFICATE OF LIABILITY INSURANCE <br />OATEIMN1`2YY, <br />n/z7n01o19 <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 <br />the 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 endomement(s). <br />PROWLER <br />Valley Regional Insurance Svcs <br />Fresno Office -Main Office <br />7576 N Ingram Ave Ste 102 <br />Fresno, CA 93711---- <br />CNM1�MTE CT Mary Thonesen <br />PHONE 1 <br />1AIC. xg8 :559446.1398 NP • 669�46-0911 <br />EE4tAIL <br />Mary Thonesen <br />INSURERS WrORaNO COVERAGE <br />NAICs <br />INSURER A: Maxtan Indemnity Ins. Co. <br />INSURED Evinger & Associates LLC <br />POBox1 <br />Klamath Falls, OR 97601 <br />INSURER B: <br />INSURER e <br />' <br />INSURERD: <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 MAY RAVE BEEN REDUCED BY PAID CLAIMS. <br />ILTR <br />TYPE OF N9UMNCEU81 <br />vaJCY NUMSEA <br />F <br />FLIPt-COW10P <br />DMRS <br />A <br />A <br />X <br />COMMERCULL GENERAL UAINUTY <br />CLAIIST4VE � OCCUR <br />Professional flab <br />X <br />BDG301093105 <br />BDG301093105 <br />07/1912019 <br />07119/2019 <br />RENCE <br />E 1,000,00 <br />i 100,00 <br />0711VA20 <br />0711912M <br />Rmerslu <br />X <br />ae Paean) <br />E 5,00 <br />ADV INJURY <br />E 1,000, <br />GEN'L AGGREGATE LIMIT APPLES PER: <br />X POLICY pr.C�T LOC <br />OTHER <br />GREGATE <br />S 2,000,000 <br />COW10P AGG <br />S 2,0001 <br />$ <br />AUTOMOBILE LIABILITY <br />ANY AUTO <br />ALL OWNED SCHEDULED <br />AUTOHIREDAUTOS AUTOSAUTOS <br />140"�ED <br />COhBMED 11 LIMIT <br />En dal <br />E <br />BODILY INJURY (PIN piIwo) <br />$ <br />BODILY INJURY (Per acadMt) <br />E <br />PROS <br />f <br />U CESSLW iaLAU <br />EXC6 <br />OCCUR <br />CL40184AADE <br />EACH OCCURRENCE <br />s <br />E _ <br />AGGREGATE <br />DED <br />RETENTION 11E <br />WORKERS COMPENSATION <br />AND ENIPOYERS LIABILITY YIN <br />ANY PROPRIETORiPARRJEILEXECUTME <br />OFFICERAIEMBER EXCLUDED? ❑MIA <br />(Ma tm h NHI <br />MpIM utla <br />IPTION OF OPERATIONS below <br />STATUTE fO.R <br />E-L EACH IN'.CIDHR <br />S <br />E.L. DISEASE -EAEAPL <br />E <br />EL DISEASE -POLICY LIMIT <br />I E <br />DESCRIPTION OF OPERATIONS ILOCATIONSIVEHICLES(ACORD 101, Addidolul Remadu SdpEW,,my M N1aclled If mon apace is re WL ) <br />The City of Santa Ana, Its officers, em loyees , agents, volunteers and <br />representatives are additional insured in regards to general liability. See <br />attached form CG 2010 0413 <br />City of Santa Ana 22019 <br />Risk Management Divisio <br />20 Civic Center Plaza, 4 <br />Santa Ana, CA 92702 AN A M. LAM <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 />AUTHORQED REPRESENTATIVE <br />Mary Thonesen <br />C)1938-2014 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD <br />