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CERTIFICATE OF <br />INSURANCE Digital <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY <br />CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, T <br />BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A <br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. <br />IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the poiLl <br />If SUBROGATION IS WAIVED, subject to the terms and conditions of thello <br />this certificate does not confer rights to the certificate holder In lieu of such at <br />PRODUCER CONE <br />NAME <br />Stata%a= Sariah Devereaux-Barrlentos, Agent PHON <br />AIc <br />1417 S Broadway <br />A. <br />nDOFI <br />Santa Ana <br />INSURED <br />Mente Inc <br />12664 W Chapman Unit 1419 <br />Garden Grove CA 92840 <br />MGHTS UP G FFRDDBE HOLDER. THIS <br />HE COWI 3AOY THE POLICES <br />BETWEEN T' E At@\F@ d`(S), AUTHORIZED <br />Daniel ResPUdi- <br />. 714-541-7".s0 <br />on <br />45417280.com <br />CA 92707 wsuRERa: State Farm General Insurance Company 25151 <br />IUSURPRR State Farm Mutual Automobile Insurance Company 25178 <br />CCIVFRArF.q CFRTIFICATF NIIMRFR- RFVIRInN NIIMRFR• <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 />NSR <br />LTR <br />TYPE OF INSURANCE <br />ADDL <br />SUBR <br />NUMBER <br />POLPOLICY <br />MM/IOIVEYYY <br />MMIDDI,YYYY <br />LIMITS <br />A <br />X <br />COMMERCIAL GENERAL LIABILITY <br />CLAIMS -MADE 1XI OCCUR <br />Y <br />92-EK-V825-4 <br />05/16/2022 <br />05/16/2023 <br />EACH OCCURRENCE <br />$ 1,000,000 <br />DAMAGE!I U KLN I LD <br />PREMISES Ea occurrence <br />$ 300,000 <br />MED EXP (Any one person) <br />$ 5,000 <br />GENT <br />X <br />PERSONAL &ADV INJURY <br />$ 1,000,000 <br />AGGREGATE LIMIT APPLIES PER: <br />POLICY 0 PECROT- ❑ LOG <br />J <br />OTHER: <br />GENERALAGGREGATE <br />$ 2,000,000 <br />PRODUCTS - COMP/OP AGG <br />$ 2,000,000 <br />BUSINESS PRPTY <br />$ 11,400 <br />AUTOMOBILE <br />LIABILITY <br />ANYAUTO <br />OWNED SCHEDULED <br />AUTOS ONLY AUTOS <br />HIRED NON-0WNED <br />AUTOS ONLY AUTOS ONLY <br />COMBINED SINGLE LIMIT <br />(Ed accident <br />$ <br />BODILY INJURY (Per person) <br />$ <br />BODILY INJURY (Peraccldent) <br />$ <br />PROPTY DAMAGE <br />PoracclERdenl <br />$ <br />$ <br />UMBRELLA LIAB <br />EXCESS LIAB <br />OCCUR <br />CLAWSWADE <br />EACH OCCURRENCE <br />$ <br />AGGREGATE <br />$ <br />DED RETENTION $ <br />$ <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY YIN <br />ANY PROPRIETOWPARTNERIEXECUTIVE ❑ <br />OFFICERIMEMBER EXCLUDED? <br />(Mandatory in NH) <br />If yes, tlesor under <br />DESCRIPTION OF OPERATIONS below <br />NIA <br />IPER OTH- <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 I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space la required) <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />City of Santa Ana <br />Risk Management Division AUTHORIZED REPRESENTATIVE <br />20 Civic Center plaza <br />Santa Ana CA 92702 <br />_r`,•a ^ REVIEWED&MPROVEDBv: <br />© 1988.2D15 ACORD I 191111 <br />ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD Ri5la Management sPeaallst <br />