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ACCOR " CERTIFICATE OF LIABILITY INSURANCE <br />DATE (MM/DD/YYYY) <br />01 /31 /2024 <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 />St Ted Bowersox <br />24681 La Plaza #360 <br />-' � <br />CONTACT Ted Bowersox <br />NAME: <br />HONateAw <br />PAIL, No, <br />o � 949-661-3200 FAX No): <br />E-MAIL <br />ADDRESS: <br />INSURER(S) AFFORDING COVERAGE <br />NAIC # <br />INSURER A: State Farm Fire and Casualty Company <br />25143 <br />Dana Point CA 926292568 <br />INSURED <br />INSURER B : <br />INSURER C : <br />JAMES GARTNER & ASSOCIATES ARCHITECTS INC <br />INSURER D : <br />2036 N BROADWAY <br />INSURER E : <br />INSURER F : <br />SANTA ANA CA 92706-2612 <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 />ADD <br />INSD <br />SUB <br />WVD <br />POLICY NUMBER <br />POLICY EFF <br />MM/DD <br />POLICY EXP <br />MM/DD <br />LIMITS <br />COMMERCIAL GENERAL LIABILITY <br />CLAIMS -MADE 1:1OCCUR <br />EACH OCCURRENCE <br />$ <br />DA AGE TENTED <br />FIRM M SES Ea occurrence) <br />$ <br />MED EXP (Anyone person) <br />$ <br />PERSONAL & ADV INJURY <br />$ <br />GEN'L <br />AGGREGATE LIMIT APPLIES PER: <br />POLICY J Q LOC <br />OTHER: <br />GENERAL AGGREGATE <br />$ <br />PRODUCTS - COMP/OP AGG <br />$ <br />$ <br />AUTOMOBILE <br />LIABILITY <br />ANYAUTO <br />OWNED SCHEDULED <br />AUTOS ONLY AUTOS <br />HIRED NON -OWNED <br />AUTOS ONLY AUTOS ONLY <br />COMBINED SINGLE LIMIT <br />Ea accident <br />$ <br />BODILY INJURY (Per person) <br />$ <br />BODILY INJURY (Per accident) <br />$ <br />Per accident <br />$ <br />UMBRELLA LIAR <br />EXCESS LIAR <br />OCCUR <br />CLAIMS -MADE <br />EACH OCCURRENCE <br />$ <br />AGGREGATE <br />$ <br />DED RETENTION $ <br />$ <br />A <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY <br />ANY PROPRIETOR/PARTNER/EXECUTIVE Y / N <br />OFFICER/MEMBEREXCLUDED? ❑ <br />(Mandatory in NH) <br />If yes, describe under <br />DESCRIPTION OF OPERATIONS below <br />N/A <br />92-MW-G697-1 <br />01/22/2024 <br />01/22/2025 <br />�/ PER OTH- <br />X TAT TE ER <br />$ <br />E.L. EACH ACCIDENT <br />$ 1000000 <br />E.L. DISEASE - EA EMPLOYEE <br />$ 1000000 <br />E.L. DISEASE - POLICY LIMIT <br />$ 1000000 <br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) <br />CERTIFICATE HOLDER CANCELLATION <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF_ NOTICE WILL BE DELIVERED IN <br />City of Santa Ana, Risk Management Division ACCORDANCE WITH THE POLICY PR( <br />li;isie Managmlent Division <br />20 Civic Center Plaza a AUTHORIZED REPRESENTATIVE i f � REVIEWED & APPROVED BY: <br />o1 A ', <br />Santa Ana CA 92702 � r-w Disk Management Specialist <br />©1988-2015 ACORD l <br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD <br />1001486 2005 155279 205 01-19-2023 <br />