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A6"R d CERTIFICATE OF LIABILITY INSURANCE AM 01/17/2o 0 I 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 INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and Conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Eddie Quillares Jr. State Farm Agency N. Broadway San � Santa Ana, CA 92701 ACT NAME: Eddie QUIIIares PHONE 714. 17.7150. Fprc 714,617.7158 7.7 Ax- EAss:eddie edtlie insurence.ctlm INSURERS AFFORDINGCOVERIIGE NAlti INSURER A: State Farm General Insurance COn1 an 25151 _ INsuR DOWNTOWN INC 204 E 4TH ST STE T SANTA ANA, CA 92701-4668 INSURER B: State Farm Fire and Casual Company 2M INSURER C: INSURER D: _ INSURER E: INSURER F : COVERAGES CERTIFICATE NUMBER:75.0450 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED 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 THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSLTR TYPE OF INSURANCE L POLICY NUMBER MMIDOY EFF WDDE W UNIT A GENERAL LABILITY Y ❑Y 92CE-Q933-0 06/05/2019 OW0512020 EACH OCCURRENCE S 1,000,000 X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE FRI OCCUR PREMISES JEs acameere $ 300,000 NED EXP(Arty one Person) S 5,000 PERSONAL S ADV INJURY s 1,000,000 GENERALAGGREGATE S 2,000,000 GEN'L AGGREGATE LIMIT APPUES PER: PRODUCTS -COMPIOPAGG S 2.000,000 17 POLICY PRO- F-1 LOC s A AUTO MOBILE LueILITY y 6215237-F28-75 12/28/2019 OB/28I2020 OMBIINE t INGLE LIMB E BODILY INJURY(Per prison) E 1,000,000 ANY AUTO �� AUTOS I X AUTOSALL OWNEDU� BODILY INJURY IPeramEenU E 1,0001000 NON -OWNED HIRED AUTOS AUTOS PROPERTY DAMAGE Per accede. 8 1,000,000 COMP/Coll Dad E 250 'III---JII A X LLALIAB X OCCUR Y Y 92CE-Q781-7 06/0512019 06/05/2020 EACH OCCURRENCE E 1,000,000 AGGREGATE b 2,000,000 XCE49 LWB EXCE3 CLAIMS -MADE DED I X I RETENTIONS 10000 It B WORKERS COMPENSATKNI AND EMPLOYERS' LIABILITY YIN 92-GA-H506-1 PROPRIETOR/PARTNEWEXECUTIVE OFRCIDMEMBER EXCLUDED? m NIA (Mandatory In NH) 06105(2019 O6/O5f2020 YOC STATU- X OTH- I CRY LIMITS IANY 1,000.000 E.L EACH ACCIDENT E 1,000.000 EL DISEASE - EA EMPLOYEE E 1.ODO,0OD ff DESCRIPTION NOFOPERATIONS nelow O E.L. DISEASE - POLICY LIMIT 3 1.000,0DO 10/0312019 10/03/2020 BOND'AMOUN' s 500.000 A FIDEL7Y BOND II --II 92-WV-6044-5 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (AUach ACORD 101, Addhimal Remarks Schedule, it more space is required) City of Santa Ana its officers, agents, employees and volunteers are named as additional insured Additional Insured endorsement issued for certificate holder. CERTIFICATE HOLDER CANCELLATION REVIEWED & APPROVED City of Santa Ana RIS MANAGEMENT DIVISION Y SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Risk Management Division 20 Civic Center Plaza, 4th fl 222020 Santa Ana, CA ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE SAMA THA M. LAMBERT © 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD 1001486 132849.7 03-01-2012