Laserfiche WebLink
�,vna„y r,y, v„ r,e"m, <br />QIp Ie1y SO11y� Da[e:2022.07.0614:04:26-OT00' <br />ACCORa CERTIFICATE OF LIABILITY INSURANCE <br />DATE(MM/DD/YYYY) <br />r <br />1111� <br />06/30/2022 <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 policy(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 require an endorsement. A statement on <br />this certificate does not confer rights to the certificate holder in lieu of such endorsements . <br />PRODUCER <br />CONTACT Karl Cres In <br />StateFarm Javier Misiego <br />PHONE 714-772-3838 FAx 714-808-6431 <br />Exit AL No: <br />1661 N. Raymond Ave Suite 102 <br />E-MAIL SS: Kari.crespin.vao3nq@statefarm.Com <br />OW. <br />-ADDR <br />INSURERS AFFORDING COVERAGE <br />NAIC p <br />INSURER A: State Farm Mutual Automobile Insurance Company <br />25178 <br />Anaheim CA 92801 <br />INSURED <br />INSURER a: State Farm Fire and Casualty Company <br />25143 <br />WESTERN AA/ INC <br />INSURER C: State Farm General Insurance Company <br />25151 <br />1592 N BATAVIA ST STE 2 <br />INSURER 0: <br />ORANGE, CA 92867 <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 />INSR <br />LTR <br />TYPE OF INSURANCE <br />ADDL <br />SUER <br />POLICY NUMBER <br />POLICY EFF <br />MM/DD/YYYY <br />POLICY EXP <br />MMIDDIYYM <br />LIMITS <br />X <br />COMMERCIAL GENERAL LIABILITY <br />CLAIMS -MADE ❑X OCCUR <br />EACH OCCURRENCE <br />g 2,000,000 <br />DAMAGE ORENTED <br />PREMISES Ea ac.m.rce <br />$ 300,000 <br />MED EXP (Any one person) <br />$ 5,000 <br />PERSONAL$ ADV INJURY <br />S 1,000,000 <br />C <br />Y <br />92-GY-D812-0 <br />10/31/2022 <br />10/31/2023 <br />GEN'L <br />X <br />AGGREGATE LIMIT APPLIES PER: <br />POLICY PRO- ❑ LOG <br />JECT <br />GENERAL AGGREGATE <br />$ 4,000,000 <br />PRODUCTS-COMPIOP AGG <br />$ 4,000,000 <br />s 248,400 <br />OTHER: <br />AUTOMOBILE <br />LIABILITY <br />Y <br />Y <br />675 9458-F02-751 <br />06/02/2022 <br />12/02/2022 <br />COMBINEDNtSINGLE LIMIT <br />fEa <br />$ 1,000,000 <br />X <br />BODILY INJURY (Par person) <br />$ <br />ANY AUTO <br />A <br />OWNED SCHEDULED <br />AUTOS ONLY X AUTOS <br />BODILY INJURY Per accident) <br />( ) <br />$ <br />X <br />HIRED X NON -OWNED <br />AUTOS ONLY AUTOS ONLY <br />PROPERTY DAMAGE <br />Peraccident <br />$ <br />X <br />UMBRELLA LIAR <br />X <br />OCCUR <br />EACH OCCURRENCE <br />$ 5,000,000 <br />C <br />EXCESS LIAR <br />CLAIMS -MADE <br />NIA <br />NIA <br />92-XC-0351-6 <br />12/14/2021 <br />12/14/2022 <br />AGGREGATE <br />$ <br />CEO RETENTION$ <br />$ <br />B <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY V <br />OFFICER/MEANY IMBER ETORPARTNERVEXEXCLUDED?ECUTIVE 1 <br />(Mandatory in NH) <br />f yesdescribe under <br />DESCRIPTION OF OPERATIONS below <br />NIA <br />Y <br />92-MW-F673-9 <br />01/01/2022 <br />01/01/202g <br />I PER OTH- <br />STATUTE ER <br />E.L. EACH ACCIDENT <br />$ 1,000,000 <br />E.L. DISEASE - EA EMPLOYEE <br />$ 1.000,000 <br />E.L. DISEASE -POLICY LIMIT <br />$ 1,000,000 <br />SURETY BOND <br />B <br />92-W6-8753-3 <br />11/17/2021 <br />11/17/2022 <br />$15,000 <br />DESCRIPTION OF OPERATIONS I LOCATIONS) VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) <br />AUDIO VISUAL SYSTEMS INTEGRATION <br />Business Location 1592 N Batavia St., Ste 2, Orange, CA 92867 <br />It is agreed that is is the intention of the Company to provide 30 days written notice prior to the cancellation of the policy designated in this certificate. However, <br />the Company assumes no liability for failure to do so. <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 <br />20 Civic Center Plaza <br />Santa Ana, CA 92702 <br />© 1988-2015 ACORD C( — rsakmamav<a:r,tawialade <br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD 41111 <br />1001486 132849,13 04-22-2020 <br />