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ACORU® CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 04/26/2022 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 endorsement(s). PRODUCER CONTACT SHELLY PADILLA NAME: Sfa h'"' rg SHELLY PADILLA A/CONNo Ext : 714-543-5858 FVC No): 714-486-2682 2424 N GRAND AVE SUITE B E-MAIL SHELLY@SHELLYPADILLA.COM INSURER(S) AFFORDING COVERAGE NAIC # SANTA ANA, CA 92705 INSURERA: State Farm Fire and Casualty Company 25143 INSURED INSURER B INSURERC: UNITED ACROSS BORDERS FOUNDATION INSURERD: 2509 W TRANSIT PL INSURER ANAHEIM, CA 92804 INSURER 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. 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 ADDL INSD SUBR WVD POLICY NUMBER POLICY EFF MM/DD/YWY POLICY EXP MM/DD/YWY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000 CLAIMS-MADE1:1 OCCUR DA PREM SESOEa oNcurrDence $ 300,000 MED EXP (Any one person) $ 5,000 92-G9-D454-1 04/29/2022 04/29/2023 PERSONAL & ADV INJURY $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 4,000,000 POLICY ❑PRO JECT ❑ LOC X PRODUCTS - COMP/OP AGG $ $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Eaaident cc $ 1,000,000 X BODILY INJURY (Per person) $ - - -- - - - -- - ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS 711 1826-B02-75 02/02/2022 02/02/2023 BODILY INJURY (Per accident) $. - -- - - - -- - PROPERTY DAMAGE Per accident $ ; HIRED NON -OWNED AUTOS ONLY AUTOS ONLY UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTN ER/EXECUTIVE OFFICE R/MEMBER EXCLUDED? Y I (Mandatory in NH) N / A 92J7J3421 03/04/2022 03/04/2023 PER OTH- STATUTE ER E.L. EACH ACCIDENT $1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1 ,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1 000 000 DESCRIPTION OF OPERATIONS / 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 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. CITY OF SANTA ANA RISK MANAGMENT DIVISION AUTHORIZED REPRESENTATIVE SANTA ANA, CA 92702 y°s T D B N REVIEWED&RPPROVEY: © 1988-2015 ACORD I °( ', e Aeevaa ACORD 25 (2016/03) The ACORD name and logo are registe d marks of ACORD Risk Management Specialist