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A` ORO® CI <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF I <br />AMEND, EXTENOOR ALTER THE COVERAGE AF <br />AUTHORIZED REPRESENTATIVE OR PRODUCEI <br />IMPORTANT: If Me certfficats holder Is an ADD <br />canditionsofthe Poilry, certainpolkles may it <br />PRODUCER <br />Kathy Lamm(975534H) <br />2915 Red Hill Ave Ste F201 <br />Costa Mesa CA 9262 <br />I INSURED <br />DINH, JAMES <br />STUDIOFOLIA <br />12723 PARK ST <br />CERRITOS CA <br />COVERAGES <br />THIS S TOCERTIFYTHATTHE POUCIES OF INSUR <br />REQUIREMENT. TERM ORCONDITION OF ANYCO <br />POLICIES DESCRIBED HEREIN 15 SUBJECT TOALLI <br />MSR - - TYPEOFINSURANCE <br />LTA <br />V COMMERCULGENEPALLUIBILRY <br />CLAIMS MADE X - OCCL <br />i <br />A <br />GEN'L AGGREGATE LIMIT APPLES PER. <br />X ROLCY PROJECT r -LOC <br />OTHER <br />AUTOMOBILELMBiLITY <br />ANVAUTO <br />A OWNEDAUTOS SCHEDUL <br />ONLY AUTOS <br />HIREDAUT05 X NON-0w <br />ONLY AUTOS OI <br />UMBRELLA LIMB OCCUR <br />—. <br />'. E%LESS LIMB CLAIMS N <br />' OED RETENTION <br />WORKERSCOMPENSATION <br />AND EMPLOYERS' LIABILDY <br />ANY PROPRIETOWPARTNERi <br />EXECUTIVE OFFICER/MEMBER <br />EXCLUDED? (Mandatory in NH) <br />If yes. describe under DESCRIPT'ON OF <br />OPERATIONS below <br />ICATE OF LIABILITY INSURANCE DATE(MM/DO;YYYY) <br />1o/2e/zols <br />ONLYAND CONFERS NO RIGHTS UPONTHE CETITIFICATE HOUER.THISCERTIFICATMIOE AFFIRMATIVELYOR NEGATIVELY <br />BE POLICIES BELOW THIS CERTIFICATE OF INSURANCE DOES NOT CONSmUTE A CONIMCTB EEN THE ISSUING INSURER(S), <br />RTIFICATEHOLDER. <br />IED, Me pariry(ies) must have ADDITIONAL INSURED onyrisions or be endorsed. ItSUBEI N IS WAIVED, subject to Me terms and <br />rsement.Astatement on Mis certificate doer not confer rights W Me certificate holder in It, <br />chendorsement(s). <br />CONTACT <br />NAME' <br />PHONE FAX <br />(A/c. NO, E%T): 866-416-8939 (A/C•N ):866.416-8939 <br />E-MAII <br />ADDRESS: klamm@famlersagent.com <br />428 <br />INSURER(S)AFFORDING COVERAGE <br />NAIC9 <br />iNSURERA: Truck Insurance Exchange <br />21709 <br />INSURER B: Farmers Insurance Exchange <br />21652 <br />INSURFRC: Mid Century Insurance Company <br />! 21687 <br />__. _ _ _- __ __ <br />T_____ <br />INSURERE <br />INSURERRER E: <br />?03 <br />INSUPER F: <br />— <br />- -- _-- <br />:ERTIFICATE NUMBER: REV15ION Nor <br />I BEU]W HAVE BEEN ISSUED TO THE INSURED I"MEABOVE FOR THE POLICY PERIOD INDICATI <br />OTHER DOCUMENT WITH RESPECT TO WHICI I . IIS CERTIFICATEMAY RE ISSUEDOR MAY PERT <br />EXCLUSIONSANDCONDITIONS OF SUCH POE c _SAIMITSSHOWNMAY WIVE BEEN REDUCED <br />TL SUBR POUCYNUMBER POLICY EFF POLICY EXP <br />D VIVO - _ _ _ (MM/DD/YYYY) (MM/DD/YYYY) <br />V 605513299 <br />I <br />i605513299 <br />02JO112019 02/01/2020 .! <br />02/01/2019 <br />i <br />) IVJITHSTANDINGANV <br />IN THE INSURANCE AFFORDED BY THE <br />N MD CLAIMS. <br />LIMITS <br />H CDRRENCE 3_ <br />1,000.000 <br />IA ETORENTED <br />$ <br />NI ES(Ea Occurrence; <br />75,000 <br />IE P(AnVnne pram) s <br />_5,000 <br />S ADV"JU Y $ <br />1,000,000 <br />IER LAGGREGATE- $ <br />2,000000 <br />O TS-COMP/OPAGG $ <br />1,000,000 <br />+— <br />ABI ED SINGLE LIMIT <br />�$ <br />1.000,000. <br />md am) <br />IILYIN)UPY(Porperson) Is <br />RLY INIURY(Peraccelennl$ <br />02101/2020 <br />__ ..{. .. <br />i PROPEI TNDAMAGE <br />(Per act dent <br />EACH C CURNFNCF 14 <br />AGGRE ATE <br />PE OTHER i$ <br />STA UTE 1 <br />EL LA <br />ACCIDENT 3 <br />5.1..015 E-EAEMPLOYEE 3 <br />E.1.015 ASE POLICY LIMIT -S <br />DESCRIMONOFOPER n(;NS/LOCATIONS/VE LES(ACORD 1100I.AAd(diittii(o�nMRemarb Schedule, may" ffiaNedifmorc apxeisrequlrad) <br />AN ADDIT12723 IONAL NSURITOS, CA ED VIA A PR03 RYbN�(jNCf)(I�' 1" A, ITS OFFICERS <br />'R1DQR¢F,A(1 NT. EMPLOYEES,0 DAV NOTICE OFAND <br />CANOELLATI NLUNTE . <br />HAVE BEEN ADDED AS <br />CERTIFICATEHOLDER <br />CITY OF SANTA ANA <br />20 CIVIC CENTER PL <br />AEI- <br />CANCELLATION <br />"� <br />SHOULDANYOFTHEABOV <br />DATE THEREOF, NOTICE WI <br />WFORIETHE EXPIRATION <br />i THE POLICY PROVISIONS. <br />SNIVIq A — HORIZED REPRESENT VE <br />/. <br />.—.. _. SANTA ANA <br />ACORD25(2016/03) f198&2015 SAC CORP RATION. All Rights Reserved <br />31-1769 11 15 The ACORD name and logo are registered marks of ACORD I <br />