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Digitally signed by Francine R. <br />Francine R. Villareal Villareal <br />Date: 2021.06.18 17:05:53-07'00' <br />A� " CERTIFICATE OF LIABILITY INSURANCE <br />F06/14/2(021/YYYY) <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 have ADDITIONAL INSURED provisions or be endorsed. <br />If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on <br />this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). <br />PRODUCER <br />BIBERK <br />P.O. Box 113247 <br />Stamford, CT 06911 <br />CONTACT <br />NAME: <br />PHONE 844-472-0967 FAx-2U3-654-3613 <br />A/C No Ext : A/C NO)7 <br />E-MAIL customerservice@biBERK.com <br />ADDRESS: <br />INSURER(S) AFFORDING COVERAGE <br />NAIC # <br />INSURER ABerkshire Hathaway Direct Insurance Company <br />10391INSURED <br />Ruby Gutierrez <br />INSURER B 7 <br />INSURER C : <br />INSURER D7 <br />200 W Columbine Ave Apt B1 <br />Santa Ana, CA 92707 <br />INSURER E 7 <br />INSURER F : <br />COVERAGES CERTIFICATE NUMBER: 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 />INSD <br />SUBR <br />WVD <br />POLICY NUMBER <br />POLICY EFF <br />MM/DD/YYYY <br />POLICY EXP <br />MM/DD/YYYY <br />LIMITS <br />X <br />COMMERCIAL GENERAL LIABILITY <br />EACH OCCURRENCE <br />$ 1,000,000 <br />CLAIMS -MADE IX I OCCUR <br />PREM SES Ea occurrence <br />$ 50,000 <br />X <br />VIED EXP (Any one person) <br />$ 5,000 <br />A <br />Primary and Non -Contributory <br />X <br />N9BP226299 06/12/2021 <br />06/12/2022 <br />PERSONAL & ADV INJURY <br />$ Included <br />GEN'L <br />AGGREGATE LIMIT APPLIES PER: <br />GENERAL AGGREGATE <br />$ 2,000,000 <br />POLICY ❑ PRO- <br />JECT LOC <br />❑ <br />PRODUCTS - COMP/OPAGG <br />$ 2,000,000 <br />X <br />$ <br />OTHER: <br />AUTOMOBILE <br />LIABILITY <br />COMBINED SINGLE LIMIT <br />Ea accident <br />$ <br />BODILY INJURY (Per person) <br />$ <br />ANY AUTO <br />OWNED SCHEDULED <br />AUTOS ONLY AUTOS <br />BODILY INJURY (Per accident) <br />$ <br />PROPERTY DAMAGE <br />Per accident <br />$ <br />HIRED NON -OWNED <br />AUTOS ONLY AUTOS ONLY <br />UMBRELLA LAB <br />OCCUR <br />EACH OCCURRENCE <br />$ <br />AGGREGATE <br />$ <br />EXCESS LAB <br />CLAIMS -MADE <br />DED RETENTION $ <br />$ <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY Y / N <br />PER OTH- <br />STATUTE I I ER <br />ANYPROPRIETOR/PARTNER/EXECUTIVE <br />E.L. EACH ACCIDENT <br />$ <br />OFFICER/MEMBER EXCLUDED? ❑ <br />NIA <br />E.L. DISEASE - EA EMPLOYEE <br />$ <br />(Mandatory in NH) <br />If yes, describe under <br />DESCRIPTION OF OPERATIONS below <br />E.L. DISEASE - POLICY LIMIT <br />$ <br />Professional Liability (Errors & <br />Per Occurrence/ <br />Omissions): Claims -Made <br />Aggregate <br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) <br />The City of Santa Ana, its officers, officials, employees, and volunteers are to be covered as additional insureds on the CGL policy with respect to liability <br />arising out of work or operations performed by or on behalf of the Contractor including materials, parts, or equipment furnished in connection with such work <br />or operations. <br />Primary and Non -Contributory endorsement is included on the general liability policy (see endorsement attached) <br />CERTIFICATE HOLDER CANCELLATION <br />City of Santa Ana <br />Risk Management Division <br />20 Civic Center Plaza <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 />i1' air- RAMallagementDMsian <br />3 �-._ REVIEWED & APPROVEDBY: <br />ACORD 25 (2016103) <br />©1988-2015 ACORD <br />larks ofACORD <br />