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Francine R. 3I9I1aIlY signed by Francine R. <br />veer 1 <br />6..�-'�� <br />li C CERTIFICATE OF LIABILITY INSURANdt <br />- ®09/02/2021 °'° <br />09/02/2021 <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 Quillares Jr. State Farm Insurance Agency <br />415 N Broadway <br />Santa Ana, CA, 92701 <br />I <br />NAMEAcT Eddie Qulllares <br />PNONE 714.617.7150. AX No:714.617.7158 <br />ADORIESS: addle eddie insurance.com <br />INSURERS AFFORDING COVERAGE <br />NAICq <br />INSURER A: Stale Farm General Insurance ComDany <br />25151 <br />INSURED ROmo Enterprises Inc. <br />DBA Orange County Maintenance Services <br />1191 La Limonar Rd <br />Santa Ana, CA 92705 <br />INSURER B: State Farm Fire and Casualty Company <br />25143 <br />INSURER C: Stale Farm Mutual Automobile Insurance Company <br />2517e <br />INSURER D: <br />INSURER E: <br />INSURER I, <br />COVERAGES CERTIFICATE NUMBER' 7S-04en RFNIBVTkI 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 INSURANCE <br />ADDL <br />SUER <br />POLICYNUMBER <br />POLICY EFF <br />MM/DDIYYYY <br />POLICY EXP <br />MMIDD/YYYY <br />LIMITS <br />A <br />GENERAL LIABILITY <br />E <br />FEY <br />92-GM-6394.0 <br />01/01/2021 <br />01/0112022 <br />EACH OCCURRENCE <br />$ 11000,000 <br />X COMMERCIAL GENERAL LIABILITY <br />CLAIMS -MADE FXI OCCUR <br />DAMAGET TED <br />PREMISES(Ed occurrence <br />$ 300,000 <br />MED EXP(Any one person) <br />$ 5,000 <br />X Loss of Income <br />PERSONAL& ADV INJURY <br />$ 1,000,000 <br />GENERALAGGREGATE <br />$ 2,000,000 <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />PRODUCTS-COMP/OP AGG <br />$ 2,OOQ000 <br />POLICY PRO- LOC <br />$ <br />C <br />AUTOMOBILE <br />LIABILITY <br />❑❑ <br />6060191-F20-75 <br />12120/2020 <br />12/20/2021 <br />Ee MBINEDtMNGL —LIMIT <br />$ 1,000,000 <br />X <br />ANY AUTO <br />ALL OS SCHEDULED <br />AUTOS AUTOS <br />HIRED AUTOS X NON -OWNED <br />AUTOS <br />BODILY INJURY (Per person) <br />$ <br />BODILY INJURY Per accident <br />( I <br />$ <br />PROPERTY DAMAGE <br />Per accident <br />$ <br />UMBRELLA LIAB <br />OCCURLID <br />EACH OCCURRENCE <br />$ <br />AGGREGATE <br />$ <br />EXCESS LIAR <br />CLAIMS -MADE <br />DEO I I RETENTION$ <br />$ <br />B <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY YIN <br />ANY PROPRIETOMPARTNEWEXECUTIVE <br />OFFICEIMEMBER EXCLUDED? Y❑ <br />N/A� <br />92-GQ-D236.8 <br />01/01/2021 <br />0110112D22 <br />WCSTATU- OTH- <br />_LIMITS X <br />1,000,000 <br />E.L. EACH ACCIDENT <br />$ 1,000,000 <br />E.L. DISEASE -EA EMPLOYEE <br />$ 1,000,000 <br />(Mandatory In NH) <br />If yea, describe under <br />E.L. DISEASE -POLICY LIMIT <br />$ 11000,000 <br />DESCRIPTION OF OPERATIONS heiso; <br />El <br />F-1 <br />DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required) <br />Pressure washing services in Downtown Santa Ana. <br />City of Santa Ana its officers, agents, employees and volunteers are named as additional 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 FLR <br />SANTA ANA, CA 92702 <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 />©1988-2010 ACORD CI <br />ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD <br />'u'°T RIAManagement DWIon <br />I222 <br />REVIEWED&APPROVED BY.' <br />') FAa$& ea k' �£naaL <br />Risk Management Analyst <br />