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Digitally signed by
<br />Francine R. Villareal Francine R. VillarealDate: 2022.01.05
<br />10:15:41 -08'00'
<br />DA 7E 4r0,M0I3JYYYYl
<br />CERTIFICATE OF LIABILITY INSURANCE
<br />11116021
<br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE, CERTIFICATE HOLDER, THIS
<br />CERTIFICATE DOE'S NOT AFFIRMIATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORD15D BY THE POLICIES
<br />BELOW. THIS CERTIFICATE OF INSURANCE DQF;S NOT CONS71TUTE A CONTRAci BETWEEN THE ISSUING INSURFRS). AUTHORIZED
<br />REPRESENTATIVE OR PRODUCER, AND THE CER111I HOLDER,
<br />IMPOIRTAN"r� if bita, cortificite holder is in ADDITIONAL, INSURED, the policy(ies) must boonclorsod, If SUET R00ATION P WAIVED. subject tO
<br />the t@rms and conditions of tho plicy, cartalivi policies may requilre an endorsement, A statement, on this cairtificato does apt confer rights to the
<br />certificate holder in lieu of such ondorsorri,anilt(s)..
<br />PRODUCER I mm . ...................... . ................ I F
<br />Van IN89ner Age ricy� PH,0NE I Ael
<br />13 5 Drive
<br />. ......................
<br />P.O. Box 901Qste Il-grisk.coin
<br />V4v&&-,,u NY 1A 7 W INSURErJs affqrup!raq cOUER E NAIC N
<br />. .......................................................... INSURER A: Ci10at Ar'nenzart Assurance Gorrlpny 20'�44 . . . . . . . .......................... . .
<br />INWRED CASADEL-01 INSURER B G I 0,3t Army li il,�,kn ITuo orance CArn a 1
<br />Casa
<br />De La Fa ills
<br />P
<br />Karina Palma -Rajas __LN5JRER.C.�
<br />. .... ..............
<br />Karin@ Pahia-Rojas
<br />. . . .. ........................ . ...... i. ...........
<br />1650 E. 4th Street # 101 Ft E R r,
<br />&inta An@ CA 92701 ...... . ... . . ...... .. . . . . ......... . . ....... .
<br />WSjURER, F �
<br />COVERAGES CERTIFICATE NUMBER: 165635(1`17t3 REVISION NUMBER,,
<br />THIS IS TO CERTIFY THAT THE PQII(',IE13 OF' INqi,JRANCE LISTED [It.,A.UmV 11AVE BEEN ISSUED TO THE INSURED NAMED ARIDVEI-'01'�, I'ME POLICY PERIOD
<br />INOIC'ATED NQTWITHSTANDING ANY RFOUIRCMENT, 11":!I4M OR OL)NDVTION OF ANY CONTRACT OR OTHER DOCUMEATWITH III TOWHICH THIS
<br />CERTIFI[t ATE MAY BE 1$,9L1FD OR MAY PERTAIN. THE INSURAINOL AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SIJHJt'0 I to ALL TIi[E TERmS,
<br />EXCLLR�10N$ AND CONr)ITIQN$ OF,$1.)CH LIMITSSHOWN MAY HAVEBEEN REDUCED BY PAID CLAIMS.
<br />................
<br />LJA 'TYPE or INSORANC E 1141sb MID POLICY NUMBER �MNJJDDNYYY� 41MMeDWYYYYr
<br />A X C OMMURC IAL GC-NeRAL, WARILITY 01. 42 L%23 411 0,1 &W2021 5612022 EACM I CCCLJRREhr.1E I I arml Dou,
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<br />GLAfMS-I`.IADE [�] OCCUR -5A "AR 7) IT b
<br />;vIr,01.110
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<br />i-11L1_1,S0—NAL%±P-V-!NL!yr ......... . . ................. .
<br />R1ENI- AV,,bREUATE, LINII r APPLIES FEfik AGGREGATr Lno wl,�,11
<br />G G POLICY JEGr LC{;
<br />ori4,p
<br />AUTO MOBILE LIABILITY COMBINED
<br />. ............ .
<br />ANY AL170
<br />. .......... . ... .
<br />ALL OWNED SCHEDULED
<br />AUTOS AUT05
<br />NON-UlAINED I
<br />IREI6AU11 Ti
<br />L AUTOS IL4-2 . . ................... .
<br />....... .......... ... . .
<br />UMBRELLA LIAD .',C.C UH EAGI I OCCLJRRCNCE ... .........
<br />F XCESS LIAla
<br />ACCIREGA7E,
<br />. ................
<br />WORKFIR5 CONIPFN9A710N I PER,
<br />&ND EMPLOYERS'LIAM) IJIY...................... .........
<br />ANY I-w)H HIF PoH"F-AH I NFH'1FXF(,;W A-'� El EACHACrIDENT $
<br />MEN�IA . ...... .......................... ..
<br />I. Mandplrry in Nlk� El DIKIASE - EA EMPU)Yrl,�' .3
<br />........... . ............... ................
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<br />JR(I" i 0 0 I`� I ID IN S b 0 1 eN E.L. DISF-ASE, POLIcY 0MI r 3
<br />A UtkAly y 'e GLP 429-3.2-4&IM 560321 5.162.012 Each
<br />'YP 22KA9 - v
<br />E3 Cybei Uabilk, y y Q u -01 WFiV2921 5M;2022 AIbe,,1MWaN
<br />.............
<br />(A,4'QRR t*I. To—&ll.11Ww.'ir i u'tks SeheduAo, onaV be atiazhad If morn space, Is rairwrqap
<br />Cily Of Santa Ana, its officors. ornploye-as. agonts, on(j roprnjabve.s are narned as additionally inGLIred on qhiS P,DliCy PUIrij@IjI 1r
<br />j t I (IF II contract, agreement,
<br />or memorandLIM of understanding. SL,Ich insjrance as is afforded by lkis pol Icy shall be primary, FInd any iPSUrance carried by City sliall bra oxcA�,,s anti
<br />norawrvl ribu lory,
<br />Certificate of lnsufanco sIrlalil Pfovido thirty t'W) �Iay prior wirlori nofte of cancpJlatiun
<br />CERTIFICATE HOLDER CANCELLATION
<br />SHIOUL D A NY OF THE ABOVE: DESCRI BE D PO LICIES, 91E AN 1Ie LLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE Wll�l- aE DELIVERED IN
<br />City of Santa Ana ACCORDANCE WITH THE, POLICY PROVISION S.
<br />Risk Management Division ........................ . .............
<br />20 Civic Center Plaza, 4th floor AUTHOM2PIJ R:EPq.EqFN7ATTWF
<br />Santa Ana CA 92701
<br />Risk MujgmadDMsIcrn
<br />59 198,a.20114 ACORD COF
<br />REviEWED&APPROVEDBY:
<br />ACORD 2fi (2014101) The ACORD narne and logo are rug istered inarks of ACORD
<br />AM=
<br />Risk Management Analyst
<br />
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