ERIC BAUER dba ALLIANCE RACE TIMING

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A /�l1 if ere CERTIFICATE OF LIABILITY INSURANCE DATE(MMODYYyy) 08I12/2021 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS POLICIES CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE HE ICIE HE POLICIES S BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURE REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) must have ADDITIONAL INSURED provisions be or endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endoreement(s). PRODUCER Sta7fCfBPFB CON C Ryan Maguire Ryan Maguire Insurance Agency Inc PNONE FAI. 916.572-0090 Fax 818-572-0495 i2210 Lake Washington Blvd Ste 120 ® E-MgIL ° DRE - ryan.maguire.y75r@statefarm.com INSURERS AFFORDING COVERAGE NAIL$ West Sacramento CA 95691 INSURERA: State Farm General Insurance Company INSURED 25151 Eric &Jennifer Bauer INSURERS: INSURER c DBA Synergy Race Timing & Alliance Race Timing I 813 W Harbor Blvd Ste. 305 INSURER 0: INSURER E: W Sacramento CA 95691 INSURER F: COVERAGES ro0rmrr ATc aD raanvo. POLICIESOF INSURANCE THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED T HEVI5ION NUMBER: TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED DOCUMENT WITH RESPECT TO WHICH THIS HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. F INSURANCE AODL SUB PO4CY EFF POLICY EXP PoUCYNUMBER M MID GENERALLU 0ILITY LIMITS ADE �X OCCUR EACH OCCURRENCE g 1,000,000 PREMISES Ee ocnnrerKa $ 1,000,000 X 90.E0.G995-1 OB/01/2021 06/01/2022 rA MED EXP (An. one PERSONALBAOVINJURY $ 1,D00,000 LIMB APPLIES PER 0. LOCPRODUCTS-COMPIOP GENERAL AGGREGATE g 2,000,000 JE AGO $ 2.000,000 Deductible $ 1,()D0 AUTOMOBILE W161UTY NGLE IMEANY a de�S $ OWNED SCHEDULED BODILY WJURY(Parpemon) $ AUTOS AUTOS ONLY AUTOS HIRED NON -OWNED BODILY INJURY (Per eerldeN) s AUTOS ONLY AUTOS ONLY Perr Pestle DAMgGE $ Collision Deductible $ UMBRELLA LIAR OCCUR EXCESS UAB EACH EACH OCCURRENCE AGGREGATE $ OEO RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY PER OTH- STA ER $ ANY PRONEMBER/PXCLUDE EXECUTIVE YIN OFFlCERRy N/A EL EACH ACCIDENT $ In NH)EXCLUDE04 (Mandatory In NH) E.L. DISEASE -FA EMPLOYE $ If yes, tlescnbe under DESCRIPnDN OF OPERATIONS below ELL DISEASE -POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, AtltlNion it Remarks Schetlule, may be attached If mom space IS required) Effective 10/21/2021 - 10/24/2021 Electronic Timing Services for 5k Race. 0 Risk A AGEMENT DIVISION G 3 2021 SAMANTkA M. LAMBERT CERTIFICATE HGI IIFR SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Santa Ana, Risk Management ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE 20 Civic Center Plaza Completed by an authorized State Farm representative. If Signature Santa Ana CA 92701 is required, please contact a State Farm agent. (D1988-2015 ACORD CORPORATION Au .;_k ..-____.-.. I ne ACLIRD name and logo are registered marks of ACORD IOU1486 132849.13 N-22-2020