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Francine R. Digitally signed by Rxndne R. Winner Villareal Date: 2021.06.29 mA038e7oU , k._o CERTIFICATE OF LIABILITY INSURANCE ATE (MMIDDIYY D06/28/2021YYI 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 lieu of such endorsement(s). - PRODUCER Eddie QUIIIareS Jr. State Farm Agency Santa Ana, CA 92701 IN415 N. Broadway San NAMEACT Eddie QUIIIareS RNCON e 714.617.7150. wC Ned :714 617.7158 ADDRESS: eddie@eddleqinsurance.com INSURERS AFFORDING COVERAGE NAIC p INSURERA: State Farm General Insurance Company 25151 INSURED DOWNTOWN INC 201 E 4TH ST SANTA ANA CA 92701-4668 INSURER B: State Farm Fire and Casualty Company 25143 INSURER C: State Farm Mutual Automobile Insurance Company 2517 INSURER D: INSURER E : INSURER F: COVERAGES CERTIFICATE NUMBER: 75-0450 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. INSR LTR TYPE OF INSURANCE ADBLS INSR U BR WVD POLICY NUMBER POLICY EFF MMIDDJYYYY1 POLICY EXP WMIDDIYYYYI LIMITS A GENERAL LIABILITY Y Y 92-CE-Q933-0 06/05/2021 06/05/2022 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE lxl OCCUR DA A ET RENTED PREMISES Pa occurrence $ 300,000 MED EXP (Any one person) $ 5,000 PERSONAL B ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPIOP AGO $ 2,000,000 POLICY PRO ECT7 Lac $ O AUTOMOBILE LIABILITY �❑ 6215237-F28.75 06/28/2021 12/28/2021 COMBINED t SINGLE LIMIT $ BODILY INJURY (Par person) $ 11000,000 ANY AUTO ALL OWNED X SCHEDULED AUTOS AUTOS BODILY INJURY Per acatlent ( ) $ 1,000,000 NON -OWNED HIRED AUTOS AUTOS PROPERTY DAMAGE Peraccidenl $ 1,000,000 Deductible $ 260 A X UMBRELLA LIAB X ri OCCUR ❑Y ❑Y 92-CE-Q781.7 0610512021 06/0512022 E4111 OCCURRENCE $ 1,000,000 AGGREGATE $ 2,000,000 EXCESS LIAB CLAIMS -MADE DIED I is I RETENTION$ 10,000 $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOWPARTNERIEXECUTIVE OFFICEIMEMBER EXCLUDED? Y❑ NIA FYI 92-GO•C512-6 06/0512021 06/0512022 WC STATIJ X OTH- vLIMITs 11000,000 E.L. EACH ACCIDENT $ "D00000 E.L. DISEASE- EA EMPLOYEE $ 1,000,000 (Mandatory in NIB If Yen donadbe under E.L. DISEASE -POLICY LIMIT $ 1,000,000 UESCE112IIIOF OPERATIONS heim A FIDELTY BOND ❑ ❑ 92-WV-6044.5 10I0312020 10/03/2021 BOND -AMOUNT $ 500.000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD101,Addilienal Remarks5chedule,itmorespacn is regulredl Scheduled Auto: 2002 GEM 825 PICKUP VIN: 5ASAK27492FO28166 Description of Operations: Downtown Santa Ana Ad Walk/ COSA Agreement A-2020-254 City of Santa Ana its officers, agents, employees and volunteers are named as additionally insured. Additional Insured endorsement issued for certificate holder with Wavier of Subrogation and non-contributory Certificate of Insurance shall provide thirty (30) day prior written notice of cancellation CITY OF SANTA ANA RISK MANAGEMENT DIVISION 20 CIVIC CENTER PLAZA 4TH FL SANTA ANA, CA 92702 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE © 1988-2010 ACORD CI ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD RFekhlanagtilnentlYnielmr. 3fl� REVIEWED 6 APPROVED BY. Risk Management Analyst