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Francine K. Villareal Villareal n.fe, omr na r n n., AM ,acoizo® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) F 1 03/26/2021 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(les) must have ADDITIONAL INSURED provisions or 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 endorsements). PRODUCER Statil Eddie Quillares Jr. State Farm Insurance A.415 N. Broadway Santa Ana, Ca 92701 CONTACT Eddie Quillares Jr. NAME: PHONEs. 714-617-7150 A/c Na 714-617-7158 nDDRESS: Eddie@EddieQinsurance.com INSURERS) AFFORDING COVERAGE NAIC # INSURERA: State Farm Fire and Casualty Company 25143 INSURED INSURER B : INSURER C : Adrlana Yazmin Martinez 548 Colston Ave INSURER D : La Puente, CA 91744 INSURERE: INSURER F COVERAGES CERTIFICATE NUMBER: 75-0450 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 LTR TYPE OF INSURANCE ADDL SUER POLICY NUMBER POLICY EFF MMIDDIYYYY POLICY EXP MMIDD/YYYV LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS MADE I OCCUR DAMAGE RENTED PREMISESS ( Ea occurrence) $ 300,000 MED EXP (Any one person) $ 5,000 Loss of Income X Deductible$500 PERSONAL B ADV INJURY $ 300,000 B Y Y 92-G8-B485-3 03/26/2021 03/26/2022 GEN'L AGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE $ 2.000,000 POLICY ❑ PRO - POLICY ❑ LOG PRODUCTS - COMP/OP AGG $ 2,000,000 $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY (Per person) $ ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY Per accident ( ) $ HIRED NON -OWNED AUTOS ONLY AUTOSONLY PROPERTY DAMAGE Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DEO RETENTION$ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ OFFICERIMEMBER EXCLUDED? NIA IPER OTH- STATUTE I I ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYE $ (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS /VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) Additional Insured: The City of San Ana, 20 Civic Center Place Santa Ana, Califorrnia 92701; Its officers, employees, agents and volunteers are named as additional Insureds. Certificate of Insurance shall provide thirty (30) day prior written notice of cancellation. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN The City of Santa Ana ACCORDANCE WITH THE POLICY PROVISIONS. Risk Management Division AUTHORIZED REPRESENTATIVE 20 Civic Center Plaza, 4th P Santa Ana, CA 92702 / ,� Risk MamagemenEDiviaiart e� f\ REVIEWED&APPROVED BY. © 1988.2015 ACORD C ACORD 25 2016103 The ACORD name and logo are registered marks of ACORD ( ) 9 9 ------ Risk Management Analyst