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Villareal <br />N-2019-125-01 <br />s. o' a CERTIFICATE OF LIABILITY INSURANCE <br />D05/2012020Y) <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(les) 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 Sariah Devereaux- Barrie ntos, Agent <br />1417 S Broadway <br />Staterarm Santa Ana, CA 92707 <br />} <br />NAME: SARIAH DEVEREAUX-BARRIENTOS <br />AICNNo EXI:714-541-7280 AIc No:714-384-3892 <br />EMAIL <br />ADDRESS: sariah.devereaux.t8lb statefarm.com <br />INSURERjSi AFFORDINGCOVERAGE <br />NAIC# <br />INSURERA : State Farm Fire and Casualty Company <br />25143 <br />INSURED Mente Inc <br />12664 CHAPMAN AVE UNIT 1419 <br />GARDEN GROVE CA 92840-4034 <br />INSURERS: <br />INSURERC: <br />INSURER D: <br />INSURER E : <br />INSURER F : <br />COVERAGES CERTIFICATE NUMBER: RFVISInN NNMRFP� <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 MAYHAVE BEEN REDUCED BY PAID CLAIMS. <br />ILTR <br />TYPE OF INSURANCE <br />INSRADDL <br />POLICY NUMBER <br />MMIDDIYYYY <br />MMIDDI <br />LIMITS <br />A <br />GENERAL LIABILITY <br />ly-1 <br />❑ <br />92-EK-V825-0 <br />W20/2020 <br />05/16/2021 <br />EACH OCCURRENCE <br />$ 1,000,000 <br />X COMMERML GENERAL LIABILITY <br />CLAIMS -MADE IOCCUR <br />PREMISES Es occunence <br />$ 300,000 <br />MED EXP(Any one person) <br />If 51000 <br />PERSONAL &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 />X1 POLICY PRO- oc <br />Business Property <br />$ 11,400 <br />AUTOMOBILE <br />LIABILITY <br />❑COMBINED(Ea <br />secant SINGLE LIMIT$ <br />BODILY INJURY (Per person) <br />$ <br />ANY AUTO <br />AAUTOOS AUTOSULEL <br />HIREDAUTOS NONI <br />AUTOS <br />BODILY INJURY (Per aoGtlent) <br />$ <br />P - DAMA <br />Peracciderd <br />$ <br />UMBRELLA LIAB <br />OCCUR <br />EACH OCCURRENCE <br />$ <br />AGGREGATE <br />$ <br />EXCESS LIAB <br />CLAIMS -MADE <br />LED RETENTION $ <br />$ <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY <br />ANY PROPRIETORIPARTNERIEYIN xECUTIVE <br />OFFICOMEMBER EXCLUDED? <br />NIA <br />RC STATU- OTH- <br />TORY LIMITS ER <br />EL EACH ACCIDENT <br />$❑ <br />EL. DISEASE - EA EMPLOYEE <br />$ <br />(Mandatory in NM <br />If yes, describe under <br />EL. DISEASE -POLICY LIMB <br />$ <br />-7 <br />❑ <br />❑ <br />DEDUCTIBLE $2000 <br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) <br />City of Santa Ana, officers, agents, employees, and volunteers are named as additionally insured on this policy pursuant to written contract, agreement, or <br />memorandum of understanding. Such insurance as is afforded bythis policy shall be primary, and any insurance carried by City shall be excess <br />30 Days Notice of Cancellation with 10 Days Notice for Non -Payment of Premium in accordance with the policy provisions. <br />City of Santa Ana SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />Risk Management Division ACCORDANCE WITH THE POLICY PROVISIONS. <br />20 Civic Center Plaza <br />Santa Ana, CA 92702 AUTHORIZED REPRESENTATIVE <br />�L4ZGC..Q. b CL(;P ,� Rick ManegementDiwra[un <br />I gry REMEWED&APPROVED Y. <br />O 1988-20 0 ACORD C <br />ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD �—� Ruk Management Analyst <br />