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CERTIFICATE OF LIA <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONL <br />CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND. <br />BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITU' <br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. <br />IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the <br />the terms and conditions of the policy, certain policies may require an 4 <br />certificate holder in lieu of such endomement(s). <br />PRODUCER <br />STATE FARM INSURANCE <br />fatefa m 1370 BREA BLVD STE. 150 <br />A FULLERTON, CA 92835 <br />W � <br />INWKEa <br />SERVICE FIRST <br />2510 N GRAND AVE SUITE 110 <br />SANTA ANA, CA 92705-8754 <br />COVERAGES CERTIFICATE NUMBER: <br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSUR <br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER <br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBE <br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS <br />TYPE OF INSURANCE <br />COMMERCIAL GENERAL LIABILITY <br />CLAIMS -MADE OCCUR <br />GENT AGGREGATE LIMIT APPLIES PER: <br />POLICY u JEQ LOC <br />A AUTOMOBILE LIABILITY G Y I Y 1 133 3423-17094S <br />ANY AUTO <br />ALLOSMED � SCHEDULED <br />Ix <br />AUTOS <br />H3RED AUTOS X NON -OWNED <br />AUTOS <br />UMBRELLA LIAR OCCUR <br />EXCESS LIAR CLAIMS -MADE <br />DED RETENTION $ <br />WORKERS COMPENSATION <br />AND EMPLOYERS" LIABILITY Y I N <br />ANY PROPRIETORIPARTNERIEXECUTIVE <br />OFFICERIMEMBEREXCLUOED? ❑ NIA <br />(Mandatory in NH) <br />If yes, describe under <br />06/0712021 1 06/07/2022 <br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Addttiooal Remarks Schedule, may be attached If more space Is requlr <br />The City of Santa Ana, Risk Management, its officers, employees, agents, representatives, and volunteers as add) <br />SHOULD ANY OF TrIE ABOvE aE5GRIBImU POLICIES BE CANCELLED OR REDUCTION IN COVERAGE BEF <br />THE ISSUING INSURER WILL MAIL *30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED 8 <br />HOLDER <br />City of Santa Ana <br />Risk Management Division <br />20 Civic Center Plaza <br />Santa Ana, CA 92702 <br />ACORD 25 (2014101) <br />TION <br />BILITY INSURANCE OATE 1- <br />08/19/29/2IY1 <br />021 <br />Y AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS <br />EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES <br />rE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED <br />policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to <br />Indorsement A statement on this certificate does not confer rights to the <br />NAME: JOEY MONTGOMERY <br />PHONE o Ext 714-528-7001 _ <br />AIC �1 AAic No :714-526-fl34$ <br />ADDRESS, JOEY@JOEYMONTGOMERY.COM <br />INSURERS AFFORDING COVERAGE <br />NAIC q <br />iNSURERA:State Farm Mutual Automobile Insurance Company <br />25178 <br />INSURERS:^_ <br />INSURERC: - <br />INSURER D : <br />INSURER E <br />INSURER F <br />NUMBER: <br />!ED NAMED ABOVE FOR THE POLICY PERIOD <br />DOCUMENT WITH RESPECT TO WHICH THIS <br />ED HEREIN IS SUBJECT TO ALL THE TERMS, <br />LIMITS <br />EACH OCCURRENCE $ <br />G TOR—LKT 0 <br />— <br />PREWSES Ea occurrence) <br />$ <br />MED EXP (Any one person) <br />$ <br />PERSONAL & ADV INJURY <br />$ <br />GENERAL AGGREGATE <br />_— <br />$ _ <br />PRODUCTS- COMPIOP AGG <br />$ <br />COMBINE SINGLELIMIT <br />Ea accident <br />$ 1,OOO,D00 <br />BODILY INJURY (Per person) <br />$ <br />BODILY INJURY (Peraccadent) <br />$ <br />PROPERTY DAMAGE <br />$ <br />;Per accident) <br />EACH OCCURRENCE <br />$ <br />AGGREGATE <br />$ <br />STATUTE ER <br />E.L. EACH ACCIDENT <br />$ <br />E.L. DISEASE - EA EMPLOYEE <br />$ <br />E.L. DISEASE -POLICY LIMIT $ <br />ad) <br />tional inured. <br />ORE THE EXPIRATION DATE THEREOF, <br />ELOW. <br />SHOULD ANY OF THE ABOVIE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />REPRESENTATIVE <br />0 1988.2014 AC <br />The ACORD name and logo are registered marks of ACORD <br />Rhie Mawgonort Divhian <br />LI-LLk1 <br />RsAEIV® & Br <br />yAmovE� <br />GIIa�., %aTG Y[f/tP.ar6 <br />Risk Marugemeni CI erica) Aide <br />