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lt!E�!Ro® CERTIFICATE OF LIABILITY INSURANCE <br />DATEI79'120Y1 <br />11/19/2021 <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 pollcy(ies) must have ADDITIONAL INSURED provisions or be endorsed. <br />If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may requirean endorsement. A statement on <br />this certificate does not Confer rights to the certificate holder In lieu of such endorsement(s). <br />PRODUCER <br />Seeman Holtz Property & Casualty - NIS <br />530 E Los Angeles Ave <br />#115-SOO <br />Moorpark, Ca 93021 <br />CON <br />NAME: Evidence of Insurance Dept, <br />Ale No Ext : 866,647.4222 pvc, No : 818568,1014 <br />ADDRESS: Caeoi@secnlanholtzpe.com <br />INSURER(S) AFFORDING COVERAGE <br />NAIC# <br />INSURER A: California Automobile Insurance Company <br />38342 <br />INSURED <br />CARLA BARBOZA <br />13ARBOZA & ASSOCIATES <br />660 SOUTH FIGUEROA STREET SUITE 1620 <br />LOS ANGELES CA 90017 <br />INSURER B : <br />INSURER C : <br />INSURER D : <br />INSURER E: <br />INSURER F: <br />COVERAGES CERTIFICATE NUMBER: REVISION 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 />LTR <br />TYPE OF INSURANCE <br />INSD <br />WVD <br />POLICY NUMBER <br />MM/DO/YVYY) <br />MM/UDIYYYY) <br />LIMITS <br />COMMERCIAL GENERAL LIABILITY <br />CLAIMS -MADE OCCUR <br />EACH OCCURRENCE <br />$ <br />PREMISES (Ea accureence) <br />$ <br />MED EXP (Any one person) <br />$ <br />PERSONAL S AOV INJURY <br />$ <br />GENT AGGREGATE LIM IT APPLIES PER: <br />POLICY ❑ PE° LOC <br />OTHER: <br />GENERAL AGGREGATE <br />$ <br />PRODUCTS - COMPIOP AGO <br />$ <br />$ <br />A <br />AUTOMOBILE <br />LIABILITY <br />ANY AUTO <br />OWNED AUTOS ONLY %� AUTOSVLEO <br />HIRED NON -OWNED <br />AUTOS ONLY AUTOS ONLY <br />BA040000063344 <br />11/12/2021 <br />11/12/2022 <br />(Ea accident) <br />$ 1,000,000 <br />BODILY I NJURY(Per parson) <br />$ <br />BODILY INJURY (Per accident) <br />$ <br />(Per accident) <br />$ <br />UMBRELLA LIAB <br />EXCESS LIAB <br />OCCUR <br />CLAIM&MADE <br />EACH OCCURRENCE <br />$ <br />AGGREGATE <br />$ <br />ICED <br />I I RETENTION <br />$ <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY YIN <br />NY PROPRIETORIPARTNER/EXECUTIVE❑ <br />FFICER/MEMBER EXCLUDED? <br />Mandatory In NH) <br />I1 yes, dasoribe under <br />ESCRIPTION OF OPERATIONS below <br />NIA <br />STATUTE ER <br />E.L. EACH ACCIDENT <br />$ <br />E.L. DISEASE, EA EMPLOYEE <br />$ <br />E.L. DISEASE -POLICY LIMIT <br />$ <br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached It more space Is required) <br />1999 BMW 328 WBABK7339XET67345 <br />CERTIFICATE HOLDER CANCELLATION <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />CITY OF SANTA ANA <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />20 Civic Center Plaza <br />AUTHORIZED REPRESENTATIVE <br />Santa Ana, CA 92701 <br />jetu Rororjam <br />©1988-2015 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD <br />