BRIAN PETERSON - Laserfiche WebLink

Home Browse Search

Francine R. Villareal `` CERTIFICATE OF LIABILITY INSURANCE Digitally signed by Francine R. Mllareal Date DATE IMMIDWYYYY) 07/26/2021 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the policy(ies) must be 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 Ileu of such endorsement(s). PRODUCER State Farm Insurance License # OG54371 IN14210 Culver Dr, Suite A, Irvine CA 92604 N MEAC RICHARD TAY a maaEl 949) 559 8866 FA� Ne (949) 269 0683 ADDRESS: PRODUCERCUSTOMR ID If 75-3918 INSURERS AFFORDING COVERAGE NAIC4 INSURED BRIAN PETERSON ART DBA FACES OF MANKIND 738 N SANTIAGO ST SANTAANACA 92701-5361 INSURERA: Stale Farm General Insurance Company 25151 INSURER B: INSURERC: INSURER D: INSURER E: INSURER F : COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILNSR TR TYPE OF INSURANCE ADDL INS R SUER POLICY NUMBER POLICY EFF MMIOO/YYYY POLICYEXP MMIOOIYVYY LIMITS A GENERAL LIABILITY _x1 COMMERCIAL GENERAL LIABILITY CLAIMS -MADE IX OCCUR �� 92•EYM1-6-81 10/30/2020 10/30/2021 EACH OCCURRENCE $ 1,000,000 PREMISES Ea oxurmnce $ 50,000 MED EXP(Any one person) $ - 51000 PERSONAL B ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE X POLICY LIMIT APPLIES PER: PRO- LOC PRODUCTS-COMPIOPAGG $ 1,000,000 $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS ❑ ❑ COMBINED SINGLE LIMIT (E. eccldenl) $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS_ -MADE ❑ ❑ EACH OCCURRENCE $ AGGREGATE $ DEDUCTIBLE RETENTION $ $ $ WORKERS COMPENSATION ANDEMPLOYERS'LIABILITY YIN ANY PROPRIETORIPARTNEMEXECUTIVE OFFICERIMEMBER EXCLUDED? ❑ 1MandatorylnNH) l ye., describe under WC STATU- OTH- TORY LIMITS EACH ACCIDENT E.L.NIA❑ $ — E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE -POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES IAU..h ACORD 101, Additional Remark. Schedule, if mare space Is required) WITH RESPECT TO GENERAL LIABILITY, NAMED ADDITIONAL INSURED FROM August 06 2021 TO November 20th, 2021 is: The City of Santa Ana, its officers, employees, agents, volunteers & representatives for the location of: 1815 Carnegie Avenue, Santa Ana CA 92705 City of Santa Ana SHOULD ANY OF THE ABOVE DESCRIB y 4 PJAMlgwganenfDivi Risk Management Division EXPIRATION DATE THEREOF, NOTICE WIL e�+9' r? REVIEWED &APPROVED BY: 20 Civic Center Plaza 8 POLICY PROVISIONS. '� r 4 4*,eW Santa Ana, CA 92701 AUTHORIZED REPRESENTATIVE RUk Mana9emenTAl ly$t Iris Tay <iris.tay.mgms@statefarm.com> 9)1988- 2009 ACORD CORPORATION. ACORD 25 (2009109) The ACORD name and logo are registered marks of ACORD 1001486 132849A 02-11-2010