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VEHICLE OR EQUIPMENT CERTIFICATE OF INSURANCE I11r�uzox`� <br />THIS OORTIPICATE tB ISSUED A$ A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE C911'"RIOATE HOi,pER. THIS <br />CERTIPICATE DOES NOT AFF[RIVIATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AF1'i7RVVD BY THE POLICIES <br />HOLQW. THIS CERTIFlroATE QF INSURANCE 0098 NOT CONST11J7E A CONTRACT BETWEEN THE 1SSUINO INSURER(S). AUTHORIZE!) <br />1115PRESENTAI]VA OR PRODUCER, AND THE CERTIFICATE HOLDng, <br />This Form Is used to ropQrt coveragoo provided to a single spoaffia vehicle orequipmant. Do not use thla form to Export liability covarago <br />provided to multiple vehtoles tinder a single pollay. Use ACORD 26 for that purpose, <br />AItOLUCk'R x sa SEpl9,h <br />SWAM $sr#ah OsvoroaLlx-OaMentoa q 714a5d7.7�U y1A�384880� <br />0 1417 s Broadway salrlah 7145417290.Dom <br />INtS1990 <br />Ana - CA 92707 <br />ROBERTO ZAVAtA CARDENAS <br />DDA COSMOS EVEN- PARTALS• <br />14132 KERRY ST <br />GARDEN GROVE CA 928" <br />J C'11G VFulr_s C no l'As11ne7C1IT <br />Stole rarm <br />YPJtR <br />MAK91101ANUPACTUREA niOr1U4. <br />#DYT9rPL <br />' VAHICLOlb#NT1m-ATIONNUM11BR <br />1094 <br />1 OMO BBoo <br />BOX <br />1ADKC34N9IR,,I518ai1 <br />Cn$CRIMipN <br />V�11C�PJkgUIPMIENtVALUE <br />MINAL NUMEJER <br />'THIS O TO t:�RTWF"Y TAT TH FOLICY(ICS) OP [IVSURaNOf; 0TED BELOW PA77HAVe 5FEN Rim) TO THIw INSUERED NAML'D A13OV6 FOR THE POLICY <br />PERI0Id(9) INDICATED, NOTWUHSfANDI•NO ANY ftQUIREMENT, TERM OR CONDITION OP ANY CGNVAGT UR. OTHER DOCUMENT WITH REEIPeOT TO <br />WHICH THIS OVITTIFICATE MAYBE ISSUC4 OR MAY PERTAIN, THE INS URANOR WORDED BY THE; ROLICY(1t$) DESCRIBED HRRCIN tSlARI3 SUajE0T T6 <br />ALL THE TERMS, EXCLUSIONS AND CONC16iIONS OF SUCH VLICY(IE$). <br />INSTt <br />LTR <br />0.ara, <br />WORD <br />TYPtt OF 019URANCE <br />POLWYAUM094- <br />pOL{OYIPFPECTRlB <br />DATE IMMIDOI"" <br />POLi0Y6kP1R0.TION <br />DATH {MitIPDWYYYYI <br />6lwyt <br />VUHICLH LIAM LtV <br />COMBINED 91NOW LIMW <br />tE 1,600,000.00 <br />eODNYINJURYQWpprnoaf) <br />6 <br />A <br />185771)1-F12r78p <br />1 11".lxOZ1 <br />12J1212p22 <br />SQDILYINJURY (Nretwldetn) <br />$ � <br />PROPERTY DANAdE <br />.«s. ., . <br />a <br />tl 1 1W1 LIA191LITY <br />rWCH{)COUR> NGfs <br />$ <br />OCCURWNCE <br />tlENt;RAL AgaKWATR <br />$ <br />L'LJAgu18 MADE <br />S <br />Rt� <br />011 <br />I <br />�Y9 <br />iYWt{1j tN9UN1iNCL <br />PaMovNUMBDR. <br />POLICY EPFHCTNE <br />DAU(MMIODNYYY) <br />P019V RIIPIRATION <br />DATL{MMIDD1f'YYY) <br />LgY1r1RInET1UCTItlLg <br />A <br />VEH onLLISION LOSS <br />105 7791-F12 76D <br />12112J=l <br />12112/2022 <br />1] ACV AGRERD AM1 <br />i Umn <br />0 STATEeAMT <br />= g00 PRO <br />A <br />vaki COMPI vtsrl 01 C 105 7751 •F12»75D <br />12117J2ti21 <br />12I12I2022 <br />© ACV J MROM AMr <br />i LOOK <br />0 C3 $TAUDAMT <br />$100 DED <br />IEQUIPMRNT (} ACV 0 AOREEDAMT <br />BASIC BROAD RO 1] $TA"I)AMT F LIMrr <br />SKCIAL $ DEO <br />UMNSURED MOtORI <br />1057101•F12.75D 1211212021 1VII02022 H11PO 250,0W)1500,000 <br />REMARKS ONaLUDINO SPECIAL DONDIr oW 1 OTNER 90VEiRMES) IAlteah ACMD 101, Addlllulfol homartw sthdoula, 60mare $peat Is rululrad) <br />Ya /IV1�1�611■IF.\lIF4T1 <br />lab ane Qf file fallewing: <br />TO ut&illI Ma11n1aIao1 doaodhatF MOW her *n added m IN AWleypaa) Datdd hortha by pellry ndrndagaj <br />A feat last tied tulltdlltedm add the add6nol InI axoel ftudbeo bolnwto Ult pNluypeol <br />Inleil k. Sl I.� h....,.h.....�....4...n.. <br />NAME AND AORRSa DIiAuDITIIINAL INTENP,D r <br />CITY OF SANTA ANA <br />20 CiVIO CENTER PLAVk <br />SANTA ARA, CA 027D1 <br />SHOULD ANY OP THE A13OV9 ORSCRISED POLICIES BE CANCKL91) <br />SePOlka TALI VXMRAVON DATR THEREOF, NQTICttW lLL BE <br />DELIVER915IN A0CC9))ANCE WITHTH0 rooUoY pROVISiQNO. <br />D94ORIMON OF 7HE ADOMONAL INTERBSr <br />iBNi)VWA I k t57xa PAYaR PAYP.$ i <br />I•CWN I LOASR NUMIIER <br />AUTROMI) AePP <br />Do not use QI <br />ACORD 23 (2010103) The ACORD name and logo are malstored marks of ACORD o ,N Rlsk ManagmmlDMslan <br />REVIEWED & NPROVm BY. <br />i <br />FR RiskManagementAnalyst <br />