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Francine R. Digitally a19oed by Frandne N.
<br />vtlareal
<br />Villareal Date: 2021.06.29 07:40:4"1'(
<br />ACCIR a CERTIFICATE OF LIABILITY INSURANCE
<br />D06/28/DDIYY
<br />2021Yv)
<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 Eddie QUIIIareS Jr.
<br />State Farm Agency
<br />Santa Ana, CA 92701
<br />IN415 N. Broadway Santa
<br />NAMTACT Eddie QUIIIareS
<br />PHC ON
<br />DID. ac No:714.6177 58
<br />ADDRESS: eddie@eddleginsurance.com
<br />INSURERS AFFORDING COVERAGE
<br />NAICp
<br />INSURER A: State Farm General Insurance Company
<br />25151
<br />INSURED DOWNTOWN INC
<br />201 E 4TH ST
<br />SANTA ANA CA 92701-4668
<br />INSURER B: State Farm Fire and Casualty Com an
<br />25143
<br />INSURER C : Stale Farm Mutual Automobile Insurance Company
<br />2 178
<br />INSURER D:
<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 INSURANCEJUR
<br />AODL
<br />SUER
<br />WVDPOLICY
<br />NUMBER
<br />POLICY EFF
<br />MM/DDIYYYY
<br />POLICY EXP
<br />(MMIDDYYYYL
<br />LIMITS
<br />A
<br />GENERAL LIABILITY
<br />E
<br />a
<br />92-CE-Q933.0
<br />06/05/2021
<br />06/05/2022
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />X COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE X OCCUR
<br />DAM IS ELATED
<br />PREMISES JEs occurrence
<br />$ 300,000
<br />MED EXP (Any one person)
<br />$ 5,000
<br />PERSONAL &ADV INJURY
<br />$ 1,000,000
<br />GENERAL AGGREGATE
<br />$ 2,000,000
<br />GEE'L AGGREGATE
<br />LIMIT APPLIES PER:
<br />PRODUCTS - COMP/OP AGG
<br />$ 2,000,000
<br />POLICY
<br />PR(I LOG
<br />$
<br />C
<br />AUTOMOBILE
<br />LIABILITY
<br />❑
<br />621 5237F28-75
<br />D6/28/2021
<br />12/28/2021
<br />EBdNDSINGLIMIT
<br />I
<br />$1
<br />BODILY INJURY (Per person)
<br />$ 1,000,000
<br />ANY AUTO
<br />ALL OWNED SCHEDULED
<br />AUTOS x AUTOS
<br />BODILY INJURY (Per accident)
<br />$ 1,000,000
<br />NON -OWNED
<br />HIRED AUTOS AUTOS
<br />PROPERTY DAMAGE
<br />Peraccident
<br />$ 1,000,000
<br />Deductible
<br />$ 250
<br />A
<br />j(
<br />UMBRELLA LIAR
<br />x
<br />OCCUR
<br />Y
<br />Y
<br />92-CE-Q781-7
<br />06/05/2021
<br />06/05/2022-EACH
<br />$ 1,000,000
<br />-OCCURRENCE
<br />AGGREGATE
<br />$ 2,000,000
<br />EXCESS LIAR
<br />CLAIMS -MADE
<br />DEO I x I RETENTION$ 10,060
<br />$
<br />B
<br />WORKERS COMPENSATION
<br />ANDEMPLOYERTLIABILITY YIN
<br />ANY PROPRIETORIPARTNERIEXECUTIVE FFICEIMEMSER EXCLUDED? Y❑
<br />N I A
<br />92-GO-0512-6
<br />06/0512021
<br />06/05/2022
<br />WC STATU- OTH-
<br />IMITS %� ER
<br />1,000,000
<br />E.L. EACH ACCIDENT
<br />$ 11000,000
<br />E.L. DISEASE - EA EMPLOYE
<br />$ 11000,000
<br />(Mandatory In NU
<br />If yes, describe under
<br />E.L. DISEASE -POLICY LIMIT
<br />$ 1,000,000
<br />DESCRIPTION F OPERATIONS bid,
<br />A
<br />FIDELTY BOND
<br />❑❑
<br />92-WV-6044-5
<br />10/03/2020
<br />10/0312021
<br />BOND -AMOUNT $ 500,000
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 1 St, Additional Remarks Schedule, it more apace is required)
<br />Scheduled Auto: 2002 GEM 825 PICKUP VIN: 5ASAK27492FO28166
<br />Description of Operations: Downtown Santa Ana Art Walk/ COSA Agreement A-2020-254
<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 Wavier 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 />ACORD 25 (2010/05)
<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 Ci
<br />The ACORD name and logo are registered marks of ACORD
<br />,/�.,,� Risk Manngti7nntt DiWelon
<br />r,REVIEWED &IAPPROVED BY:
<br />1 Risk Management Analyst
<br />
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