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Tracy Digitally signed by Tracy Jacobs D ACC)RU CERTIFICATE OF LIABILITY Iacobs o :34:1 �----�YYY) 1 l0 /20 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 REPRESENTATIVEOR 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 hollder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Next Furst Insurance Agency, Inc. _ PHONE. _._ FAX ... tAFC. No. Exti: 222-5010 A/C Not: I PO Box 60787 E-MAIL ADDRESS: supp' ortCnexti,nsurance.com Palo Alto, CA 94306 IN:SURER.S. AFFORDING COVERAGE NAIL. fd INSURER A :. State National insurance Company, Inc. 12831 ................... INSURED'_'_'_.__.....�...mm.__ INSURER B: .. Oscar Ramirez Marl tra INSURER C :_. 1520 E Wellington Ave INSURER D Santa Ana, CA 92701 . INSURER E : INSURER F :. COVERAGES CERTIFICATE NUMBER: 212180089 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 WI-11CH 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 OF INSURANCE ADDTYPE INSD WVD POLICY NUMBER EFF MMIUDFYYYY MMPOLICY L ICY EXP DD/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S1,000,000.00 CLAIMS -MADE ', 1 OCCUR. DAMAGE T(i fdENTE,D PREMISES IEa ut;t.urranca 5100,000..00 .�. MVED EXP j'Any cane person) $S,000.00 PERSONAL BADVINJURY $1.000,000.00 m A X X NXTIOVKRHP4-00-GL 09/116/2022 09/16/2.,023 GEN"L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE. a2,.000,000.00X. X ❑ JEC POLICYT ❑ LOC C PRODUCTS ._COMPfCJPAGG 2,OC70,p00.d)0mm- $.. ....--- OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIM'.IT... Ea accident S, BODILY INJURY (Per person) $ ...... ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per aooidenfy'. 5 �..... HIRED NON -OWNED AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE....... Per accident ........ $ $ UMBRELLA LIAR OCCUR .._ EACH OCCURRENCE $ AGGREGATE $ . ....... ....... EXCESS LIAR CLAtlM.S-MADE'. ..___ ..._._ .._..._. _......-.. DE RETENTIONS: WORKERS COMPENSATION AND EMPLOYERS" LIABILITY Y (N PER OTH- STATUTE ER E.L. EACH ACCIDENT .-- $ ANYPROPRVETOR:PARTNERIEKECUI"fVE 0FRCER/MEMSER EXCLUDED? ❑ NIA E.L. (DISEASE - EA EMPLOYEE ._...... 5 (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLOY 1_.IMIT 5 DESCRIPTION OF OPERATIONS I LOCATIONS f VEHICLES (ACORD 101, Additional Ramarks Schedule, may be attached U more space is required) The Certificate Holder is City of Santa Ana, Parks, Recreation and Communit Service, A General Liability ))Waiver of Subrogation applies in Favor of this City of Santa Ana, Parks, Recreation and COIUrnun'Ry Service. City of Santa Ana, Parks, Recreation and Community Service are an Additional Insured on the General Liability policy on a primaryand non-contributory basis. All Certificate Holder privileges apply only If required by written agreement between the Certificate Holder and the insured!, and are subject to policy terms and conditions. CANCELLATION City of Santa Ana, Parks, Recreation and Community Service LIVE CERTIFICATE 20 Civic Center Piz SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Santa Ana, CA 92701 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE @ 1988-2015 ACORD ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD REVIEWED & APPROVED Or �— Risk Management Analyst