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CERTIFICATE OF LIABILITY INSURANCE I DATE ovm2o2o1712020 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). ACT PRODUCER Eddie QUIIIares Jr. NAME: Eddie Qulllares ONE State Farm Agency A&N,_ew.714 617 7150 i C Rot: 714.617.7 EWAIL 415 N. Broadway ADDREss, eddie@eddleglnsurance.eom Santa Ana, CA 92701 INSURERts�AFFORo1NGcoyEMGE wvcF INSURER A: State Farm General Insurance Company — 151 INSURED DOWNTOWN INC INSURER B: State Farm Fire and Casualty Company 2543 204 E 4TH ST STE T INSURERC: SANTA ANA, CA 92701-4668 INSURER 0: INSURER E IN USSR F: CnVFRAr9FS CFRTIFICATF NIIMRFR-74_ndcn Qmviel IM MIIMQFQ- 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. IN56 A L LTR. TYPE OF INSURANCE R. POLICY EFF POLICY EXP POLICY NUMBER MMD MWDO W LIMITS GENERAL LIABILITY 0610512020 A Y V 92-CE-0933-0 O6lDS/2079�_T ❑-❑ EACH OCCURRENCE S I 1.000.000 X IAL GENERAL LIABILITY PREMISES (Ee oawmnw)_ _ 300.000 CIAIM&MADE FI. OCCUR ,_ _S MEG EXP 1Aaymel>arean) § 5,000 PERSONALB AOV INJURY S 11000.000 l —E_. GENERAL AGGREGATE S 2.000.000 - _ GEN G_A_TE LIMIT APPLIES PER AGO 2.000.000 PRP F POLICY . '' LOC POLICY _PRODUMS-COMPIOP IS 'S AUTOMOBILE LABILITY y q ❑ 621 5237-F28-75 122812019 06l28/2020 ❑ COMBINED SINGLE LIMIT _(Es aeaCmdZ — _ s _ ANY AUTO _ _. i BODILY INJURY IPer person) § 1,000.000 AOX SCHEDULED _ _ ' AUTOS _ _ AUTOS BODILY INJURY (Per awaent 1 S 1.000,W0 NON-MNEO HIRED AUTOS AUTOS _ pR«P� DAMAGE �IS -- 1.ODD,000 Comp/Coll Ded a 250 A X _ OCCUR Y �� UMBRELLA LIAB X g2-CE-078/-7 0610512019 O6/0512020 EACH OCCURRENCE --...... $ 1.000,000 —i EXCESS LIA6 C'CC':MADEI —._ AGGREGATE S 2,000.000 § DEO X RETENTION 10,000 B WORKERS COMPENSATION I WC STATU- X OTH- 1.000,000 AND EMPLOYERS' LIASILRY YIN 92-GA-H506-1 06/05/2019 0610512020 MIT .--' F.B_ _ ANY PROPRIETORIPARTNEWEXECUTIVE ��y-� MIA a OFFICEIMEMBER EXCLUDED? E.L. EACH ACCIDENT § I,000.000 LJ (Mandatary In NH) E.L. DISEASE- EA EMPLOYES S 1.000.000 If yes, Ees`d under DESCRIPTION OF OPERATIONS I,ebw E.L. DISEASE - POLICY LIMIT I S '- 1.000.000 A FIDELTY BOND ❑'❑l 92-WV-6044Z 10J0312019 1010312020 BO"OUNT S SW.000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (At ACORD 101. Additional Remarks SchaEele. It more spaga is required) City of Santa Ana its officers. agents, employees and volunteers are named as additional insured Additional Insured endorsement issued for CeNficate holder. CERTIFICATE HOLDER CANCELLATION REVIEWED & APPROVED City of Santa Ana RIS MANAGEMENT DIVISION Y SHOULD ANY OF THE ABOVE DESCRIBED POUCHES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Risk Management Division ACCORDANCE WITH THE POLICY PROVISIONS. 20 Civic Center Plaza, 4th fl 2 2 2020 Santa Ana, CA 92702 AUTHORIZED REPRESENTATIVE SAMA THA M. LAMBERT @ 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD 1001486 132849.7 03-01-2012