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A� d CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDOIYYYY) 6/24/2020 THIS CERTIFICATE 15 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 C NTA T Van Wagner Agency 135 Crossways Park Drive PHONE FAX . 800-735-1588 N 888-290-0302 AE,,'R"Ess vanwagnerinsurancelDstedingrisk.com P.O. Box 9017 INSURERS AFFORDING COVERAGE NAIC0 Woodbury NY 11797 INSURER A: Great American Assurance Company 26344 Licenses- INSURED CASAVEL41 INSURER e: Casa De La Familia Karina Palma -Rojas INSURER C INSURER D Karina Palma -Rajas 1650 E. 4th Street#101 INSURER E: Santa Ana CA 92701 INSURER F COVERAGES CERTIFICATE NUMBER: 1207416509 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. [NSA LT TYPE OF INSURANCE ADOLSUBR POLICY NUMBER POLICY EFF IMNUDPIYYYYI POLICY EXP (MMIDDfYYYYILIMITS A X I COMMERCIAL GENERAL LIABILITY CLAIMS -MADE O OCCUR Y Y GLP 4293 84I5 SBI2020 ✓ 616U2021 ✓ EACH OCCURRENCE 31000000 L� n n SIN'(100 MED EXP An one persm $ 5.000 PERSONAL& ADVINAl1RY 51,000,00o GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $3,000.00D X POLICY0JJECOT n LOG PRODUCTS - COMP/OP AGG $3.0000DO $ OTHER: AUTOMOBILE LIABILITY COMBINEDSINGLE LIMIT (Ea a cileni $ BODILY INJURY (Per person) S ANY AUTO ALL OPINED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMA E P r $ NON -OWNED HIRED AUTOS AUTOS 3 UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE S EXCESS LIAB CWMS-MADE DED I I RETENTION Is WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN TA E ERµ EL EACH ACCIDENT $ ANY PROPRIETORPARTNERVEXECU IVE OFFICERIWMSER EXCLUDED? ❑NIA E.L, DISEASE - EA EMPLOYE $ (Mandatary In NH) If yes. desoibeunder DESCRIPTION OF OPERATIONS be. E.L. DISEASE -POLICY LIMB 1 $ A Professional Liability / GLP 429.3 "e 5S 020 MQ021 Each madent 5100D000 � / Aggregate $3,000,000 DESCRIPTION OF OPERATIONS 1 LOCATIONS VEHICLES(ACORO 101. Additional Remarks Schedule. may be attached If more spaceis required)�� O lnnrTn`/L City of Santa Ana, officers, employees, agents, volunteers, and representatives are named as additionally insured on�$y 1 sG4fifflJfNr 1, agreement, or memorandum of understanding. Such insurance as is afforded by this policy shall be primary, and any W VFAiQq&C,&j;IDW"Wess and noncontributory. L'Y e1 Certificate of Insurance shall provide thirty (30) day prior written notice of cancellation. ✓ JU 2020 CERTIFICATE HOLDER CANCELLATION / ✓ SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Santa Ana ACCORDANCE WITH THE POLICY PROVISIONS. Risk Management Division AUTHORIZED REPRESENTATIVE 20 Civic Center Plaza, 4th floor Santa Ana CA 92701 C 1988.2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD