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Digitally slyned by Francine R. Francine R. Villareal Villareal CERTIFICATE OF LIABILITY INSURANCE DA06/08/aD(YYYrj 06l08/2021 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 poitcy(les) must have ADDITIONAL INSURED provlslons or 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 lieu of such andomement s . PRODUCER $tateArM TERRY BRADSHAW, AGENT LIC. 1WB80831 NaACT KAREN VASQUEZ PHONE Eel 714-637-4120 F X 8s: 714-637.4260 17871 SANTIAGO BLVD., SUITE 207 ro VILLA PARK, CA 92861 MAIL KARENQ7ERRYBRADSHAW.ORG R 38: INSURERS AFFORDING COVERAGE NAIC if INSURER A: State Farm General Insurance Company 25151 INSURED INSURER 0 : State Farm Mutual Automobile Insurance Company 25178 HENNESSEY & HENNESSEY, LLC. INSURER C: 1760217TH STREET, SUITE 102-246 _ INSURER D: TUSTIN. CA 92780 IN UREA 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. NOTWITHSTANDINO 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. TYPE CF IHBURANCE PL SUSR POLICY UMBER POLICY PMUC EXPLIMITS rNS COMMERCIAL. GENERAL LIAaILfY CLAIM&MADE �OCCUR Y Y 92-CZ-W382-6 05/16/2021 05116/2022 EACH OCCURRENCE $ 1,000,000 co 300,000PREMISES $MEDEXP(Aayoneperren) $ 5,000 PERSONALSADVINJURY $ 1,000.000 GENT AGGREGATE LIMIT APPLIES PER: X POLICY ❑ jECi LOC OTHER: GENERAL AGGREGATE $ 2,000,000 PRODUCTS -COMPIOP AGO $ 2,000,D00 $ B AUTOMOBILE X LIABILITY ANY AUTO OWNED SCHEDULED AUTOS ONLYAUTOS HIRED �/ NON -OWNED AUTOSONLY /� AUTOS ONLY Y Y 471 7092-E19-75G 0511912021 l l/19/2022 COMBINED SINGLE LIMITa 1.000,000 BODILY INJURY (Par person) S -. BODILYINJURY(PmacoBvmj $ PROPERTY OAMA Pore a " A X UMBRELLALIAB EXCESSLIAd X OCCUR CLAIMS -MADE N N 92-CZ-W386.5 06/16/2021 05/15/2D22 EACH OCCURRENCE ,000,000 !$j2' AGGREGATE 000,000 DEO I I RE TION _ $ WORKERS COMPENSATION AND EMPLOYERS'LIARILRY YIN OFFICE OPRIETERAPARTNERIEEXCLU ECUTIVE O (Mendaforyln NN{ If SCdescdb0Rnder DESCRIPTION OF OPERATIONS edma NIA PE TfITE OR E.L. EACH ACCIDENT $ E.L. DISEASE •EA EMPLOY $ E.L- DISEASE -POLICY LIMIT $ ' DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES tACORD 101, Addlllonal Remarks Samdula, maybe Mlaehed if more apace Is faqulmd) City of Santa Ana, officers, agents, employees, and volunteers are named as additionally Insured on this policy pursuant to written contract, agreement, or memorandum of understanding. Such Insurance as Is afforded by this policy shall be primary, and any insurance carded by City shall be excess and noncontributory Certificate of Insurance shall provide thirty (30) day prior written notice of cancellation SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE )AiEREOP, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE_POtJCy PROVISIONA 0 / CITY OF SANTA ANA RISK MANAGEMENT DIVISION AUTHORIZEDREPRESENTATIIIE 20 CIVIC CENTER PLAZA Completed by an aUthor• ed State SANTA ANA, CA 92702 Is required, please contact a State ©1988.2015 ACORD i ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD f R, k" Risk Marlagmnlent Analyst