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AC40)?"® Ca CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYY ) 03/02/2022 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 have ADDITIONAL INSURED provisions 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 endorsements). PRODUCER SfafeFarm SHELLY PADILLA 2424 N GRAND AVE SUITE B 's SANTA ANA, CA 92705 CONTACT SHELLY PADILLA NAME: gHONN E 714-543-5858 AIC Ne: 714-486-2682 E-MAIL ADOREss. SHELLY@SHELLYPADILLA.COM INSURER S AFFORDING COVERAGE NAIC 0 INSURERA: Slate Farm Fire and Casualty Company 25143 INSURED UNITED ACROSS BORDERS FOUNDATION 2509 W TRANSIT PL ANAHEIM, CA 92804 INSURER B INSURER C: INSURERD: INSURER E: INSURER F : CnvcRAC-ES CERTIFICATE NUMBER: REVISION NUMBER: y 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. INBR LTR rypE OF INSURANCE ADDL SUBR POLICY NUMBER M.OIL DDfYYVY MMLDDIYYYY1 LIMITS X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE ❑ OCCUR 92-G9-D454-1 04/29/2021 04/29/2022 EACH OCCURRENCE $ 2,000,100 DAMAGE TO RENTED PREMISES Ea occurrence $ 300,000 MED EXP (Any one person) $ 5,000 PERSONAL aADV INJURY $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRO-JECT ❑ LOC X POLICY OTHER: GENERAL AGGREGATE $ 4000 000 PRODUCTS - COMP/OPAGG $ AUTOMOBILE LIABILITY X ANYAUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY 7111826-BO2-75 02/02/2022 02/02/2023 COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY (Per person) $100,000 BODILY INJURY (Par accident) $300,000 PROPERTY DAMAGE Peraccident $100,000 $ UMBRELLA LIAB EXC ESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE _ $ AGGREGATE _$ DIED RETENTION$ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNERIEXECUTIVE YIN OFFICER/MEMBER EXCLUDED9 FY-1 (Mandatory in NEI If yes, describe under DESCRIPTION OF OPERATIONS below N/A 92J7J3421 03/04/2022 03/04/2023 STATUTE ERPERH E.L. EACH ACCIDENT $1,000,000 E.L. DISEASE - EA EMPLOYEE $1,000,000 E.L. DISEASE- POLICY LIMIT $1 00O 000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) City of Santa Ana Risk Management Divisions its Officers, Officials, Employees, and Volunteers 20 Civic. Center Plaza Santa Ana, Ca 92702 CITY OF SANTA ANA RISK MANAGMENT DIVISION 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 /I @ 1988-2015 ACORD ACORD 25 (2016103) The ACORD name and logo are registe d marks of ACID Risk ManwheatDMe[aA REVIEWED&APPRgOqVm Sr. Risk Management Sperlalut