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Digitally signed by Francine R.
<br />Francine R. Villareal Villareal
<br />a us
<br />�C_E _—(_—D E(MMI2020YY)_—
<br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
<br />CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
<br />BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
<br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
<br />IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the
<br />terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the
<br />certificate holder In lieu of such endorsement(s).
<br />PRODUCER Eddie Qulllare6 Jr.
<br />CACT
<br />NAME: Eddie QUIIIareS
<br />PHON e t 714.617.7150. ac No 714 617.715
<br />State Farm Agency
<br />415 N. Broadway
<br />Santa Ana, CA92701
<br />nooRESS: eddle ci addle insurance.com
<br />INSURERS AFFORDING COVERAGE
<br />NAIC#
<br />INSURER A: State Farm General Insurance Company
<br />25151
<br />INSURED DOWNTOWN INCORPORATED
<br />INSURER B: State Farm Fire and Casualty Company
<br />25143
<br />INSURER C;
<br />204 E 4TH STE STE T
<br />INSURERD:
<br />SANTA ANA, CA 92701-4668
<br />INSURER E :
<br />INSURER F:
<br />COVERAGES CERTIFICATE NUMBER: 75-0450 REVISION NUMBER:
<br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
<br />INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />INSR
<br />LTR
<br />TYPE OF INSURANCE
<br />ADDL
<br />INSR
<br />SUBR
<br />WVD
<br />POLICY NUMBER
<br />POLICY SEE
<br />MMIDDNYYY
<br />POLICY EXP
<br />MWEIDIWYY
<br />LIMITS
<br />A
<br />GENERAL LIABILITY
<br />Y
<br />Y
<br />92•CE-g933.0
<br />06/05/2020
<br />0610512021
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />PREMISES Fri occur ante
<br />$ 300,000
<br />X COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE OCCUR
<br />MED EXP (Any one person)
<br />$ 5,000
<br />PERSONAL S ADV INJURY
<br />$ 1,000,000
<br />GENERAL AGGREGATE
<br />$ 2,000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />PRODUCTS - COMP/OP AGO
<br />$ 2,000,000
<br />X POLICY PRp- LOG
<br />$
<br />AUTOMOBILE
<br />LIABILITY
<br />❑
<br />❑
<br />621 5237-F28-75
<br />06/2812020
<br />12/28/2021
<br />COMA
<br />Eaa aoclarad) NGLE LIMIT
<br />$
<br />BODILY INJURY (Per person)
<br />$ 1,000,000
<br />ANY AUTO
<br />ALL OWNED x SCHEDULED
<br />AUTOS AUTOS
<br />BODILY INJURY(Peraccident)
<br />$ 1,000,000
<br />PROPERTY DAMAGE
<br />Per accident
<br />$ 1,000,000
<br />HIRED AUTOS X NON -OWNED
<br />AUTOS
<br />Deductible
<br />$ 250
<br />A
<br />X
<br />UMBRELLA LAB
<br />)(
<br />OCCUR
<br />Y
<br />Y
<br />92-CE-Q781.7
<br />0610512020
<br />06/051202,
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />AGGREGATE
<br />$ 2,000,000
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />DEO I x I RETENTION$ 10,000
<br />$
<br />B
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY YIN
<br />ANY PROPRIETORIPARTNERIEXECUTIVE
<br />OFFICEIMEMBER EXCLUDED? Y�
<br />(Mandatory In NH)
<br />NIA
<br />Y
<br />FYI
<br />92-GF-S797-1
<br />06/05/2020
<br />06/05/2021
<br />We STATU- X 0EH
<br />1,000,000
<br />E.L. EACH ACCIDENT
<br />$ 1,000,000
<br />E.L. DISEASE - EA EMPLOYEE
<br />$ 1,000,000
<br />E.L. DISEASE -POLICY LIMIT
<br />$ 1,000,000
<br />/Yes, describe under
<br />DESCRIPTION OF OPERATIONS W,
<br />A
<br />FIDELITY BOND
<br />❑Y
<br />❑Y
<br />92-WV-6044-5
<br />10/03/2020
<br />10/03/2021
<br />BOND -AMOUNT $ 500,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required)
<br />Scheduled Auto: 2002 GEM 825 PICKUP VIN: 5ASAK27492FO28166
<br />City of Santa Ana its officers , agents, employees and volunteers are named as additionally insured.
<br />Additional insured endorsement issued for certificate holder with waiver of subrogation and non-contributory.
<br />Certificate of Insurance shall provide thirty (30) day prior written notice of cancellation
<br />CITY OF SANTA ANA
<br />RISK MANAGEMENT DIVISION
<br />20 CIVIC CENTER PLAZA 4TH FL
<br />SANTA ANA, CA 92702
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS,
<br />AUTHORIZED REPRESENTATIVE
<br />ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD
<br />3 s RISkMclwgzlnmLDAtiefaR
<br />,q REVIEWED & APPROVED, BY:
<br />fAb Y+SRuk Management Analyst
<br />
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