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ACCM o® CERTIFICATE OF LIABILITY INSURANCE DATE(MMNOIYYYY) s124/2020 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 Van Wagner Agency 135 Crossways Park Drive P.O. Box 9017 CONT CT PHONE FAX 800-735-1588 x : 868-290-0302 EJAAII vanwa nerinsurance stedin risk.com Woodbury NY 11797 INSURER(S) AFFORDING COVERAGE NAICN INSURER A: Great American Assurance Company 26344 bcensek_ BR-1418528 INSURED CASADE1,01 INSURER 8: Casa De La Familia Karin Palma -Rojas INSURER C Karma Palma -Rojas INSURER D: 1650 E. 4th Street #101 Santa Ana CA 92701 INSURER E 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. INSR LTA TYPE OF INSURANCE AO L e POLICY NUMBER MW�DYEYY PMID�� LIMITS A X COMMERCIALGENERALLUBILITY CIAIMS.MADE Q OCCUR Y Y GIP 42&3 "5 5162020 5"2021 ✓ EACH OCCURRENCE sI'Vea000 s� 0 Mu 0 rt n $100,000 MED EXP M one person $5.000 PERSONAL B ADV INJURY $1,000,000 GENE AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $3.000,000 X POLICY ❑ jECOT LOC PRODUCTS-COMPIOPAGG $3.W0,000 S OTHER' AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident) $ BODILY INJURY(Perp.rum) S ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per ac dem) $ PROPERTY DAMAGE P $ NON -OWNED HIREDAUTOS HAUTOS $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAR CLAIMS.MADE DED I I RETENTIONS Is WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN PSTEARTURE ERµ ANY PROPRIETOPoPARTNEWEXECUTIVE E.L. EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED. ❑NIA EL DISEASE - EA EMPLOYE $ (Mandator, In NH) Rryas.describaunder DESCRIPTON OF OPERATIONS below E.L. DISEASE -POLICY LIMIT I $ A Pmless,cral Lunelity / GLP 42933 W 5182mo SIBr2021 Each Indent S1,DOO= / Aggregate 53000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be anached N more space/ Is reaulred)�� p An(]n(1�)['1 City of Santa Ana, officers, employees, agents, volunteers, and representatives are named as additionally insured on a0$ IdLvtlTiall.tdlT ut, agreement, or memorandum of understanding. Such insurance as is afforded by this policy shall be primary, and any I WRM W�hlqq.1bYArmNdd$4��J#Sldffess and noncontributory. L'�T Certificate of Insurance shall provide thirty (30) day prior written notice of cancellation. ✓ JU 2920AL TVFdo 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 ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD IIM